BACKGROUND AND OBJECTIVES: Experimental and clinical data have suggested b-blockers protective hemodynamic effects during anesthesia and surgery. This study aimed at reviewing pharmacological and clinical information needed to prescribe b-blockers in perioperative medicine. CONTENTS: Selective b-blockers inhibit preferentially b1-receptors, decreasing heart rate and inotropism leading to less myocardial oxygen consumption. Non-selective b-blockers also inhibit b2-receptors, increasing bronchial and peripheral vascular resistance. Some b-blockers are also vasodilators. Prolonged treatment with b-blockers increases cell membrane b-receptors density, which may explain sympathetic hyperactivity observed during treatment interruption. In non-cardiac surgeries, beneficial effects of b-blockers have been observed in hypertensive patients and in patients with coronary artery disease, with a decrease in postoperative myocardial ischemia and overall two-year mortality. CONCLUSIONS: Continued administration of b-blockers until anesthesia induction has been encouraged except in patients with signs of intolerance such as hypotension or significant bradycardia. b-blockers have been shown to have beneficial effects on postoperative outcomes in patients with cardiovascular disease or risk factors. Hence, their more widespread use in perioperative medicine is encouraged.
DRUGS, Interaction
