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08:50
Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy
Published on: June 25, 2013
β-blocking agents for surgery: influence on mortality and major outcomes. A meta-analysis
Joanne Guay1, E Andrew Ochroch
1University of Montreal, Montreal, Quebec, Canada.
Journal of Cardiothoracic and Vascular Anesthesia
|June 25, 2013
Summary
Adding beta-blockers perioperatively reduces 1-year mortality risk in surgical patients. While this intervention increases stroke risk, the survival benefit appears to outweigh the harm, warranting careful consideration in clinical practice.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Perioperative beta-blockade is a common strategy to manage cardiovascular risk in patients undergoing surgery.
- The optimal use of beta-blockers, including whether to continue or stop them, or to initiate them perioperatively, remains a subject of debate.
Purpose of the Study:
- To re-evaluate the impact of perioperative beta-blockade on mortality and major adverse outcomes following surgical procedures.
- To compare the effects of stopping/continuing versus adding beta-blockers in the perioperative period.
Main Methods:
- A comprehensive meta-analysis of parallel randomized controlled trials (RCTs) published in English.
- Electronic searches were conducted through university databases to identify relevant studies.
- Included patients were undergoing various surgical interventions.
Main Results:
- Stopping beta-blockers pre-surgery did not significantly alter myocardial infarction risk (RR, 1.08).
- Adding beta-blockers perioperatively reduced 1-year all-cause mortality (RR, 0.56; NNT 28) and 0-30 day myocardial infarction (RR, 0.65; P=0.006).
- However, adding beta-blockers increased the risk of stroke (RR, 2.18; NNH 177).
Conclusions:
- Perioperative beta-blockade demonstrates a significant reduction in 1-year mortality risk.
- The observed survival benefit from adding beta-blockers appears to outweigh the increased risk of stroke.
- These findings support the judicious use of beta-blockers in selected surgical patients to improve outcomes.
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