title: Vascular surgery patients prescribed preoperative β-blockers experienced a decrease in the maximal heart rate observed during induction of general anesthesia.
abstract: OBJECTIVE
  To investigate the association of preoperative β-blocker usage and maximal heart rates observed during the induction of general anesthesia.
  
  
  METHODS
  Retrospective descriptive, univariate, and multivariate analyses of electronic hospital and anesthesia medical records.
  
  
  METHODS
  A tertiary-care medical center within the Veterans Health Administration.
  
  
  METHODS
  Consecutive adult elective and emergent patients presenting for vascular surgery during calendar years 2005 to 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 430 eligible cases, 218 were prescribed β-blockers, and 212 were not taking β-blockers. The two groups were comparable across baseline patient factors (ie, demographic, morphometric, surgical duration, and surgical procedures) and induction medication doses. The β-blocker group experienced a lower maximal heart rate during the induction of general anesthesia compared with the non-β-blocker group (105 ± 41 beats/min v 115 ± 45 beats/min, respectively; p < 0.01). Adjusted linear regression found a statistically significant association between lower maximal heart rate and the use of β-blockers (β = -11.1 beats/min, p < 0.01). There was no difference between groups in total intraoperative β-blocker administration.
  
  
  CONCLUSIONS
  Preoperative β-blockade of vascular surgery patients undergoing general anesthesia is associated with a lower maximal heart rate during anesthetic induction. There may be potential benefits in administering β-blockers to reduce physiologic stress in this surgical population at risk for perioperative cardiac morbidity. Future research should further explore intraoperative hemodynamic effects in light of existing practice guidelines for optimal medication selection, dosage, and heart rate control.
authors.affiliation: Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA. mudumbai@stanford.edu
authors.forename: Seshadri C
authors.initials: SC
authors.lastname: Mudumbai
authors.forename: Todd
authors.initials: T
authors.lastname: Wagner
authors.forename: Satish
authors.initials: S
authors.lastname: Mahajan
authors.forename: Robert
authors.initials: R
authors.lastname: King
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Mark
authors.initials: M
authors.lastname: Hlatky
authors.forename: Arthur
authors.initials: A
authors.lastname: Wallace
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects; D003864:Depression, Chemical; D004334:Drug Administration Schedule; D004341:Drug Evaluation / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011229:Preanesthetic Medication; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000187:drug effects; D014656:Vascular Surgical Procedures
chemical_list: D000319:Adrenergic beta-Antagonists