[Beta-blockers in flow of time--view of an anaesthesiologist and intensivist]

Beta-blockers are used for several decades also for the suppression of symptoms of the adrenergic stress in the perioperative period. While their benefit is considered indisputable there is no consensus on the most suitable patients' population where benefits would prevail over the risks most significantly. Present trends suggest the shift from the frequent widespread use to the more targeted medication, where the general status of the patient as well as the nature of the operation is being considered. Individual dose should be targeted to the specific therapeutic end-points. While the non-therapeutic use of beta-blockers by lay public is possible there is growing interest in their therapeutic use in severely septic patients. Favourable clinical experience results mostly from their use in the burned patients, where the natural course of the illness has many similarities with the protracted course of severe sepsis. Favourable influence of beta-blockers on monotonous tachycardia with minimal reflex variability of heart rate and on the resulting mortality has been demonstrated. Clinical experience has accumulated up to date reflecting the use of propranolol mostly; the experience with the more cardioselective beta-blockers is mostly experimental. Although there are legitimate worries about possible circulatory depression by beta-blockers empirical data do not support this. There are very encouraging data available about the favourable effect of beta-blockers on the outcome of the traumatised patients, especially patients suffering from a brain trauma.