The effect of perioperative beta-blockade on the pulmonary function of patients undergoing major arterial surgery.
BACKGROUND
Concern about the potential detrimental side-effects of beta-blockade on pulmonary function often dissuades against their perioperative use in patients undergoing major arterial surgery (especially in those with chronic obstructive pulmonary disease (COPD)). In this study we aimed to establish prospectively the clinical relevance of these concerns.


METHODS
After ethics committee approval and individual informed consent, the pulmonary function of twenty patients (mean age 68.7 years (range 43-82), 11 males) scheduled to undergo non-emergency major vascular surgery was studied by recording symptoms and spirometry before and after institution of effective beta-blockade. Fifteen patients (75%) had significant smoking histories (mean pack years/patient=50), while 12 (60%) had COPD.


RESULTS
All patients tolerated effective beta-blockade satisfactorily without developing either subjective deterioration in symptoms or significant change on spirometry. The mean change in FEV1 following adequate beta-blockade was 0.05+/-0.24 liters (95% CI -0.06 to +1.61), p=0.35, giving a mean percentage change of 3.18%+/-11.66 (95% CI -2.26 to 8.62).


CONCLUSIONS
Previously held concerns about worsening pulmonary function through the short-term use of beta-blockers should not dissuade their perioperative usage in patients with peripheral vascular disease. Furthermore, the accuracy of pulmonary function tests in preoperative assessment and risk stratification also appears unaffected by this therapy.
Kieran
S M
SM
Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
Cahill
R A
RA
Browne
I
I
Sheehan
S J
SJ
Mehigan
D
D
Barry
M C
MC
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006801:Humans; D007432:Intraoperative Period; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists