Beta-receptor blockade and spinal anaesthesia. Withdrawal versus continuation of long-term therapy

A prospective study was performed in 43 men scheduled for transurethral resections under spinal anaesthesia. All patients were on chronic beta-receptor blockade because of hypertension and/or ischaemic heart disease. The patients were randomly subjected to either a gradual preoperative withdrawal or a continuation of the beta-receptor blockade. Haemodynamics were measured non-invasively. Spinal anaesthesia was performed and an i.v. injection of atropine given. The patients were then placed in a lithotomy position. Mean anaesthetic level included T6. After beta-receptor blocker withdrawal consistently elevated heart rates, a high incidence of arhythmias, angina pectoris and postoperative ST-T changes indicating myocardial ischaemia were seen. These changes were not seen in patients with continued beta-receptor blockade. Withdrawal of beta-receptor blockers was also associated with an increased total peripheral vascular resistance in connection with spinal anaesthesia. These results suggest that patients on long-term beta-receptor blockade should continue the therapy during and after spinal anaesthesia.