Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

BACKGROUND: The use of β-blockers during the perioperative period remains controversial. Although some studies have demonstrated their protective effects regarding postoperative cardiac complications, others have demonstrated increased mortality when β-blockers were introduced before surgery. METHODS: In this observational study involving 1,801 patients undergoing aortic reconstruction, we prospectively assessed β-blocker therapy compared with no β-blocker therapy, with regard to cardiac and noncardiac postoperative outcomes using a propensity score approach. The impact of β-blockers was analyzed according to the intraoperative bleeding estimated by transfusion requirements. RESULTS: In-hospital mortality was 2.5% (n=45), β-blocker use was associated with a reduced frequency of postoperative myocardial infarction (OR=0.46, 95% CI [0.26; 0.80]) and myocardial necrosis (OR=0.62, 95% CI [0.43; 0.88]) in all patients, but also with an increased frequency of multiple organ dysfunction syndromes (OR=2.78, 95% CI [1.71; 4.61]). In patients with severe bleeding (n=163; 9.1%), the frequency of in-hospital death (OR=6.65, 95% CI [1.09; 129]) and/or multiple organ dysfunction syndromes (OR=4.18, 95% CI [1.81; 10.38]) were markedly increased. Furthermore, no more than 28% of the patients who died presented with postoperative myocardial infarction, whereas 69% of the patient with a postoperative myocardial infarction also presented an excessive bleeding. CONCLUSIONS: Perioperative β-blocker therapy was associated with an overall reduction in postoperative cardiac events. In the vast majority of patients with low perioperative bleeding, the global effect of β-blockers was protective; in contrast, patients given β-blockers who experienced severe bleeding had higher mortality and an increased frequency of multiorgan dysfunction syndrome.

Original publication

DOI

10.1097/aln.0b013e31825adaea

Type

Journal article

Journal

Anesthesiology

Publication Date

12/2012

Volume

117

Pages

1203 - 1211

Addresses

University Pierre et Marie Curie-Paris 6, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. yannick.le-manach@psl.aphp.fr

Keywords

Aorta, Abdominal, Humans, Cardiovascular Diseases, Blood Loss, Surgical, Adrenergic beta-Antagonists, Treatment Outcome, Perioperative Care, Hospital Mortality, Prospective Studies, Aged, Middle Aged, Female, Male, Acute Kidney Injury, Percutaneous Coronary Intervention