[Perioperative beta-blockade for reduction of cardiovascular complications in non-cardiac surgery: advantages and disadvantages].
The results of the recently published PeriOperative ISchemic Evaluation (POISE) trial show that perioperative use of metoprolol in patients with atherosclerosis undergoing major non-cardiac surgery reduces the risk of cardiovascular complications. This effect was primarily produced by a 1.5% reduction in non-fatal myocardial infarction (MI), but this advantage was outweighed by a 0.8% increase in total mortality and a 0.5% increase in nonfatal stroke. These results, combined with previous meta-analyses, confirm that non-fatal MI is reduced at the cost of a statistically significant increase in stroke rate and a near significant increase in mortality. It is likely that the increase in complications is due to a high dose of metoprolol being given too shortly before the operation. These findings call for judicious perioperative use of adrenergic beta-antagonists in cardiac-high-risk patients undergoing high risk non-cardiac surgery. Dosage should be lower and administration should be implemented longer before the operation.
Koelemay
M J W
MJ
Academisch Medisch Centrum, Universiteit van Amsterdam, Afd. Chirurgie, G5-153, Postbus 22.600, 1100 DD Amsterdam. m.j.koelemaij@amc.uva.nl
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D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008790:Metoprolol / Q000009:adverse effects / Q000627:therapeutic use; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D008790:Metoprolol