Routine beta-blockade in vascular surgery.
We have evaluated the safety and efficacy of routine beta-blockade for the prevention of cardiac complications in a comprehensive series of patients undergoing major vascular surgery and amputation for atherosclerotic arterial disease. From 1 December 2001 to 31 May 2002, patients received perioperative beta-blockade by atenolol. Outcomes in this period were compared to the immediately antecedent 6 months. The main outcome measure was the occurrence of cardiac complications. Fifty-three patients underwent surgery in the first period and 54 in the second. After introduction of routine beta-blockade, only one patient suffered cardiac complications compared to 10 in the first period (P=0.01). There were eight deaths in the first and two in the second period (P=0.052). On multivariate analysis, treatment with beta-blockers was the only variable significantly associated with a decrease in cardiac morbidity (OR=0.12; 95% CI=0.002-0.66; P=0.014). Two patients suffered bronchospasm leading to discontinuation of atenolol. Routine perioperative beta-blockade was safe and reduced the occurrence of cardiac complications after vascular surgery.
Torella
Francesco
F
Department of Surgery, Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK. fcmtdr@aol.com
de Cossart
Linda
L
Dimitri
Sameh K
SK
Edwards
Paul R
PR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000671:Amputation, Surgical; D000704:Analysis of Variance; D001161:Arteriosclerosis / Q000601:surgery*; D001262:Atenolol / Q000627:therapeutic use; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008485:Medical Audit; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*
D000319:Adrenergic beta-Antagonists; D001262:Atenolol