The effect of beta-blocker dosing strategy on regulation of perioperative heart rate and clinical outcomes in patients undergoing vascular surgery: a randomized comparison.
The optimal dosing strategy for perioperative beta-blockers to safely achieve recommended target heart rates (HRs) by current guidelines is not well defined. An HR-titrated perioperative beta-blocker dosing regimen versus a fixed-dose regimen was assessed by clinical outcomes, postoperative heart rate, and beta-blocker-related complications. Patients (n = 64) scheduled to undergo moderate- to high-risk vascular surgery and without contraindications to beta-blockade were randomized to either a fixed-dose or HR-titrated beta-blocker dosing schedule. Clinical outcomes and HRs were followed immediately preoperatively to 24 hr postoperatively. A difference in mean HR between the two dosing arms was significant immediately postoperatively (70.1 vs. 58.2 bpm for fixed dose and HR-titrated arms, respectively; p = 0.012) but at no other time points. However, the HR-titrated strategy led to a significant reduction in the percentage of HR measurements >80 bpm (34.5% vs. 16.1%, p < 0.001) and to a significant reduction in absolute HR change (17.5 vs. 22.5 bpm, p = 0.034). There were no significant differences in the occurrence of asymptomatic hypotension between the two study arms, and no beta-blocker-related adverse events occurred in either study arm. An aggressive, HR-titrated perioperative beta-blocker dosing strategy was associated with more consistent maintenance of postoperative HRs within the range recommended by current guidelines and did not result in increased drug-related adverse events. The question of what is the best perioperative beta-blocker dosing regimen warrants further evaluation in a large-scale clinical trial.
Division of Vascular Surgery, Penn State College of Medicine, Lehigh Valley Hospital, Allentown, PA 18016, USA.
Paul
P
Cesanek
Nanette
N
Schwann
Eric
E
Wilson
Sallie
S
Urffer
Crystal
C
Maksimik
Susan
S
Nabhan
Joe
J
Ottinger
Jeff
J
Astbury
Yufei
Y
Xiang
Martin E
ME
Matsumura
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D000319:Adrenergic beta-Antagonists; D002317:Cardiovascular Agents