Long-term beta-receptor blockade--adrenergic and metabolic response to surgery and neurolept anaesthesia

Twenty-six patients on chronic (greater than 3 months) beta-receptor blocking therapy due to ischaemic heart disease and/or hypertension were randomly distributed to a 4-day gradual withdrawal (n = 13) or a continuation of ordinary therapy until a planned cholecystectomy under neurolept anaesthesia (n = 13). Plasma-adrenaline, -noradrenaline, -potassium, -glycerol, -FFA, -insulin and b-glucose were determined perioperatively. The metabolic response to surgery was as expected with hyperglycaemia and depressed insulin levels, which did not differ significantly between the two groups of patients. Plasma-catecholamines showed the highest mean values during emergence from anaesthesia. Plasma-adrenaline and -potassium were constantly highest in the beta-receptor-blocked patients, who also showed indices of a relatively depressed lipolysis compared to patients in whom beta-receptor blockers had been withdrawn. These discrepancies between withdrawal versus continuation of preoperative beta-receptor blockade seemed to be of small clinical importance and did not oppose the present view that beta-receptor blockers should generally be continued during surgery. However, findings in individual patients suggest that beta-receptor blockade may maintain hypoglycaemia in catabolic patients.