Neuroprotection is associated with beta-adrenergic receptor antagonists during cardiac surgery: evidence from 2,575 patients.
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.
Amory
David W
DW
Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Heart Center, Durham, NC 27710, USA.
Grigore
Alina
A
Amory
John K
JK
Gerhardt
Mark A
MA
White
William D
WD
Smith
Peter K
PK
Schwinn
Debra A
DA
Reves
J G
JG
Newman
Mark F
MF
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
D000319:Adrenergic beta-Antagonists; D018696:Neuroprotective Agents