title: Neuroprotection is associated with beta-adrenergic receptor antagonists during cardiac surgery: evidence from 2,575 patients.
abstract: OBJECTIVE
  To determine the impact of perioperative beta-adrenergic receptor (betaAR) antagonist administration on neurologic complications.
  
  
  METHODS
  Observational database analysis.
  
  
  METHODS
  A clinical investigation at a single tertiary academic medical center.
  
  
  METHODS
  Elective coronary artery bypass graft surgical patients operated on in the period 1994-1996.
  
  
  METHODS
  Patients were divided into 2 groups: (1) patients given betaAR antagonist-blocking drugs in the perioperative period, including during operation, and (2) patients not given betaAR antagonists.
  
  
  RESULTS
  betaAR antagonist use in 2,575 consecutive patients undergoing coronary artery bypass graft surgery (1994-1996) was determined using the Cardiovascular Database and Anesthesia Information System Database. Outcome variables were postoperative stroke, coma, and transient ischemic attack. Of patients, 113 (4.4%) had postoperative neurologic complications, including stroke (n = 44), coma (n = 12), and transient ischemic attack (n = 3). Of patients, 2,296 (89%) received perioperative betaAR antagonist therapy, and 279 (11%) did not. Adverse neurologic events occurred in 3.9% (n = 90) of patients who received perioperative betaAR antagonists and 8.2% (n = 23) of patients who did not receive betaAR antagonists (odds ratio, 0.45; 95% confidence interval, 0.28 to 0.73; p = 0.003, unadjusted.) Severe neurologic outcomes (stroke and coma) occurred in 1.9% (n = 44) of patients who received betaAR antagonists and 4.3% (n = 12) of patients who did not receive betaAR antagonists (odds ratio, 0.43; 95% confidence interval, 0.23 to 0.83; p = 0.016).
  
  
  CONCLUSIONS
  Use of beta-adrenergic antagonists was associated with a substantial reduction in the incidence of postoperative neurologic complications. A prospective randomized trial is needed to verify this potentially important neuroprotective strategy in cardiac surgery.
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Heart Center, Durham, NC 27710, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Amory
authors.forename: Alina
authors.initials: A
authors.lastname: Grigore
authors.forename: John K
authors.initials: JK
authors.lastname: Amory
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gerhardt
authors.forename: William D
authors.initials: WD
authors.lastname: White
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.forename: Debra A
authors.initials: DA
authors.lastname: Schwinn
authors.forename: J G
authors.initials: JG
authors.lastname: Reves
authors.forename: Mark F
authors.initials: MF
authors.lastname: Newman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D003128:Coma / Q000209:etiology / Q000517:prevention & control; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D000319:Adrenergic beta-Antagonists; D018696:Neuroprotective Agents