scholarly journals Anesthetic implications and role of preoperative beta blockade in esophageal substitution with stomach in pediatric surgical patients

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Raksha Kundal ◽  
Ranju Singh ◽  
Subhasis Roy Choudhury ◽  
Partap Singh Yadav ◽  
Ajai Kumar ◽  
...  
Keyword(s):  
Beta Blocker ◽  
Beta Blockers ◽  
Anesthetic Management ◽  
Beta Blockade ◽  
Level Of Evidence ◽  
Thoracic Epidural ◽  
Postoperative Ventilation ◽  
Esophageal Substitution ◽  
Complications And Mortality ◽  
Gastric Pull Up

Abstract Background There is a paucity of literature on the anesthetic management of pediatric esophageal substitution using the stomach. We did a retrospective analysis of all such cases done at our institution. We analyzed the patient’s demography, indication, and type of surgery, co-morbid conditions, anesthesia techniques, duration of postoperative ventilation, hospital stay, complications, and mortality. The use of beta-blockers and their effect on the incidence of intraoperative and postoperative tachycardia in gastric pull-up patients was also analyzed. Results Thirty-four cases of gastric substitution of the esophagus in children were done over 19-year period; gastric pull-up was done in 28 patients and a gastric tube was made in 6 patients. General anesthesia was given to all; a thoracic epidural for pain was sited in 25 patients. Twenty-eight patients were ventilated postoperatively; the mean duration of ventilation is 54 h. Significant intraoperative tachycardia was observed in 85.7% of patients without beta-blocker as compared to 23.8% patients with beta-blocker (p = 0.004). Postoperatively, tachycardia was absent in patients receiving beta-blocker and present in 71.4% of patients not receiving beta-blockers (p < 0.001). Overall mortality was 8.8% but mortality due to cardiac arrhythmia was 42.9% in the patients not receiving beta-blockers (p = 0.001). Conclusions A thorough preoperative preparation, control of tachyarrhythmias, postoperative ventilation, and pain management is recommended for a favorable outcome. In addition, our paper supports the preoperative use of beta-blockers in reducing the incidence of fatal tachyarrhythmias associated with gastric pull-up surgery without any serious adverse effects. Level of evidence Level III

scholarly journals Acute Surgical Anemia Influences the Cardioprotective Effects of β-Blockade

2010 ◽  
Vol 112 (1) ◽  
pp. 25-33 ◽  
Author(s):  
W Scott Beattie ◽  
Duminda N. Wijeysundera ◽  
Keyvan Karkouti ◽  
Stuart McCluskey ◽  
Gordon Tait ◽  
...  
Keyword(s):  
Beta Blocker ◽  
Major Adverse Cardiac Event ◽  
Cardiac Event ◽  
Propensity Scores ◽  
Beta Blockers ◽  
Adverse Cardiac Event ◽  
Beta Blockade ◽  
Cardiac Events ◽  
Cardioprotective Effects ◽  
The Relationship

Background Despite decreasing cardiac events, perioperative beta-blockade also increases perioperative stroke and mortality. Major bleeding and/or hypotension are independently associated with these outcomes. To investigate the hypothesis that beta-blockade limits the cardiac reserve to compensate for acute surgical anemia, the authors examined the relationship between cardiac events and acute surgical anemia in patients with and without beta-blockade. Methods The records of all noncardiac, nontransplant surgical patients between March 2005 and June 2006 were retrospectively retrieved. The primary outcome was a composite that comprised myocardial infarction, nonfatal cardiac arrest, and in-hospital mortality (major adverse cardiac event). The lowest recorded hemoglobin in the first 3 days defined nadir hemoglobin. Propensity scores estimating the probability of receiving a perioperative beta-blocker were used to match (1:1) patients who did or did not receive beta-blockers postoperatively. The relationship between nadir hemoglobin and major adverse cardiac event was then assessed. Results This analysis identified 4,387 patients in whom nadir hemoglobin could be calculated; 1,153 (26%) patients were administered beta-blockers within the first 24 h of surgery. Propensity scores created 827 matched pairs that were well balanced for all measured confounders. Major adverse cardiac event occurred in 54 (6.5%) beta-blocked patients and in 25 (3.0%) beta-blocker naive patients (relative risk 2.38; 95% CI 1.43-3.96; P = 0.0009). The restricted cubic spline relationship demonstrated that this difference was restricted to those patients in whom the hemoglobin decrease exceeded 35% of the baseline value. Conclusions beta-Blocked patients do not seem to tolerate surgical anemia when compared with patients who are naive to beta-blockers. Prospective studies are required to validate these findings.

Effects of incremental beta-blocker dosing on myocardial mechanics of the human left ventricle: MRI 3D-tagging insight into pharmacodynamics supports theory of inner antagonism

2015 ◽  
Vol 309 (1) ◽  
pp. H45-H52 ◽  
Author(s):  
Boris Schmitt ◽  
Tieyan Li ◽  
Shelby Kutty ◽  
Alireza Khasheei ◽  
Katharina R. L. Schmitt ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Beta Blocker ◽  
Low Dose ◽  
Beta Blockers ◽  
Area Under The Curve ◽  
Beta Blockade ◽  
Low Doses ◽  
Ventricular Performance ◽  
Selective Blockade ◽  
Time To Peak

Beta-blockers contribute to treatment of heart failure. Their mechanism of action, however, is incompletely understood. Gradients in beta-blocker sensitivity of helically aligned cardiomyocytes compared with counteracting transversely intruding cardiomyocytes seem crucial. We hypothesize that selective blockade of transversely intruding cardiomyocytes by low-dose beta-blockade unloads ventricular performance. Cardiac magnetic resonance imaging (MRI) 3D tagging delivers parameters of myocardial performance. We studied 13 healthy volunteers by MRI 3D tagging during escalated intravenous administration of esmolol. The circumferential, longitudinal, and radial myocardial shortening was determined for each dose. The curves were analyzed for peak value, time-to-peak, upslope, and area-under-the-curve. At low doses, from 5 to 25 μg·kg−1·min−1, peak contraction increased while time-to-peak decreased yielding a steeper upslope. Combining the values revealed a left shift of the curves at low doses compared with baseline without esmolol. At doses of 50 to 150 μg·kg−1·min−1, a right shift with flattening occurred. In healthy volunteers we found more pronounced myocardial shortening at low compared with clinical dosage of beta-blockers. In patients with ventricular hypertrophy and higher prevalence of transversely intruding cardiomyocytes selective low-dose beta-blockade could be even more effective. MRI 3D tagging could help to determine optimal individual beta-blocker dosing avoiding undesirable side effects.

scholarly journals Effects of beta-blocker therapy on mortality after elective colon cancer surgery: a Swedish nationwide cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036164 ◽  
Author(s):  
Rebecka Ahl ◽  
Peter Matthiessen ◽  
Gabriel Sjölin ◽  
Yang Cao ◽  
Göran Wallin ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Cancer Surgery ◽  
Beta Blockade ◽  
Blocker Therapy ◽  
Colon Cancer Surgery ◽  
Cancer Specific Mortality ◽  
Elective Colon

ObjectiveColon cancer surgery remains associated with substantial postoperative morbidity and mortality despite advances in surgical techniques and care. The trauma of surgery triggers adrenergic hyperactivation which drives adverse stress responses. We hypothesised that outcome benefits are gained by reducing the effects of hyperadrenergic activity with beta-blocker therapy in patients undergoing colon cancer surgery. This study aims to test this hypothesis.DesignRetrospective cohort study.Setting and participantsThis is a nationwide study which includes all adult patients undergoing elective colon cancer surgery in Sweden over 10 years. Patient data were collected from the Swedish Colorectal Cancer Registry. The national drugs registry was used to obtain information about beta-blocker use. Patients were subdivided into exposed and unexposed groups. The association between beta-blockade, short-term and long-term mortality was evaluated using Poisson regression, Kaplan-Meier curves and Cox regression.Primary and secondary outcomesPrimary outcome of interest was 1-year all-cause mortality. Secondary outcomes included 90-day all-cause and 5-year cancer-specific mortality.ResultsThe study included 22 337 patients of whom 36.1% were prescribed preoperative beta-blockers. Survival was higher in patients on beta-blockers up to 1 year after surgery despite this group being significantly older and of higher comorbidity. Regression analysis demonstrated significant reductions in 90-day deaths (IRR 0.29, 95% CI 0.24 to 0.35, p<0.001) and a 43% risk reduction in 1-year all-cause mortality (adjusted HR 0.57, 95% CI 0.52 to 0.63, p<0.001) in beta-blocked patients. In addition, cancer-specific mortality up to 5 years after surgery was reduced in beta-blocked patients (adjusted HR 0.80, 95% CI 0.73 to 0.88, p<0.001).ConclusionPreoperative beta-blockade is associated with significant reductions in postoperative short-term and long-term mortality following elective colon cancer surgery. Its potential prophylactic effect warrants further interventional studies to determine whether beta-blockade can be used as a way of improving outcomes for this patient group.

scholarly journals Perioperative Beta-blockade: Guidelines and Practice in New Zealand

2005 ◽  
Vol 33 (5) ◽  
pp. 645-650 ◽  
Author(s):  
J. Weller ◽  
Z. Karim
Keyword(s):  
At Risk ◽  
New Zealand ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Beta Blockade ◽  
Adrenergic Blockade ◽  
Cardiac Events ◽  
Patients At Risk ◽  
Risk Patients ◽  
Barriers To Implementation

The aim of our study was to describe the knowledge and practice of New Zealand anaesthetists in relation to perioperative beta-adrenergic blockade, and to define barriers to implementation of perioperative beta-blockade in surgical patients at risk of myocardial ischaemia. A survey was sent to 400 New Zealand specialist anaesthetists. Information was sought on their knowledge and current practice relating to perioperative beta-blockade, and the barriers encountered to implementing therapy. The response rate was 59%. Perioperative beta-blockade was seen as beneficial in at risk patients by 95% of responding anaesthetists, but practice varied widely. Only 45% of anaesthetists always or usually commenced a beta blocker perioperatively, a department protocol was available to only 20%, and understanding of indications and contraindications to beta-blockade varied. There were logistical difficulties when initiating and monitoring perioperative beta-blocker regimens, and where treatment required multidisciplinary commitment. The lack of clarity of the guidelines was also a barrier to more widespread use. Difficulties were encountered relating general guidelines to individual patients, when co-morbidities, concurrent treatment and the influence of regional or general anaesthesia may influence the risk/benefit ratio. This study has identified variations in practice and reasons why New Zealand anaesthetists use of perioperative beta-blockers is at odds with published guidelines. Deficiencies in the guidelines are part of the problem. However, even with consensus on guidelines, effective multidisciplinary strategies will be required to optimize treatment of patients at risk of perioperative cardiac events.

scholarly journals Beta-blockade is not associated with improved outcomes in isolated severe extracranial injury: an observational cohort study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Lin Sadi ◽  
Gabriel Sjölin ◽  
Rebecka Ahl Hulme
Keyword(s):  
Beta Blocker ◽  
Injury Severity ◽  
Beta Blockers ◽  
Patient Characteristics ◽  
Trauma Centre ◽  
Secondary Outcome ◽  
Cardiac Complications ◽  
Beta Blockade ◽  
Included Patient ◽  
Student’S T

Abstract Background There is evidence supporting the use of beta-blockade in patients with traumatic brain injury. The reduction in sympathetic drive is thought to underlie the relationship between beta-blockade and increased survival. There is little evidence for similar effects in extracranial injuries. This study aimed to assess the association between beta-blockade and survival in patients suffering isolated severe extracranial injuries. Methods Patients treated at an academic urban trauma centre during a 5-year period were retrospectively identified. Adults suffering isolated severe extracranial injury [Injury Severity Score (ISS) ≥ 16 with Abbreviated Injury Score of ≤ 2 for any intracranial injury] were included. Patient characteristics and outcomes were collected from the trauma registry and hospital medical records. Patients were subdivided into beta-blocker exposed and unexposed groups. Patients were matched using propensity score matching. Differences were assessed using McNemar’s or paired Student’s t test. The primary outcome of interest was 90-day mortality and secondary outcome was in-hospital complications. Results 698 patients were included of whom 10.5% were on a beta-blocker. Most patients suffered blunt force trauma (88.5%) with a mean [standard deviation] ISS of 24.6 [10.6]. Unadjusted mortality was higher in patients receiving beta-blockers (34.2% vs. 9.1%, p < 0.001) as were cardiac complications (8.2% vs. 1.4%, p = 0.002). Patients on beta-blockers were significantly older (69.5 [14.1] vs. 43.2 [18.0] years) and of higher comorbidity. After matching, no statistically significant differences were seen in 90-day mortality (34.2% vs. 30.1%, p = 0.690) or in-hospital complications. Conclusions Beta-blocker therapy does not appear to be associated with improved survival in patients with isolated severe extracranial injuries.

scholarly journals Rate control drugs differ in the prevention of progression of atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Koldenhof ◽  
E.P.J.P Wijtvliet ◽  
N.A.H.A Pluymaekers ◽  
M Rienstra ◽  
R.J Folkeringa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Beta Blocker ◽  
Rate Control ◽  
Beta Blockers ◽  
Randomised Trial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Beta Blockade ◽  
Ventricular Ejection Fraction ◽  
A Prospective Study

Abstract Background In patients with paroxysmal atrial fibrillation (PAF), verapamil reduces progression to persistent AF through its intracellular calcium-lowering effects. Little is known on the effects of beta-blockade. Methods In this pre-specified post-hoc analysis of the RACE4 randomised trial (nurse-led care versus usual-care in newly detected AF) all patients with PAF and treated with beta-blockers or verapamil for rate control, were analyzed. Patients using class I or III antiarrhythmic drugs were excluded. The primary outcome was time to first electrical cardioversion (ECV) for non-selfterminating persistent AF. Event rates are reported using Kaplan-Meier analysis, and multivariate analysis was used to correct for baseline differences. Results Out of 430 patients with PAF, 383 used beta-blockers and 47 verapamil. Compared to verapamil patients, patients on beta-blocker were significantly older (60±12 versus 66±9 years), had a higher CHA2DS2-VASc score (1.5 versus 2.0) and a lower left ventricular ejection fraction (60% versus 55%). There were no other significant baseline differences between the two groups. Over a mean follow up of 36 months, 99 out of 430 (23%) patients underwent a first ECV after progression to persistent AF. In the beta-blocker group 95 of 383 (25%) patients underwent ECV, compared to 4 out of 47 (9%) in the verapamil group (P=0.013, Figure 1). After correction for baseline differences verapamil remained significantly associated with less progression (OR 0.23, confidence interval 0.08 to 0.67). Similarly, ECV or chemical cardioversion, whichever came first, was performed in 113 of 383 (30%) beta-blocker patients and 7 of 47 (15%) verapamil patients (P=0.022). In total 35 atrial ablations were performed, 34 (9%) in the beta-blocker group and only 1 (2%) in the verapamil group (p=0.075). Conclusion In patients with newly diagnosed PAF, verapamil was associated with less progression to persistent AF, as compared to beta-blockers. In order to draw firm conclusions, these results need to be confirmed by a prospective study ECV free survival Funding Acknowledgement Type of funding source: None

scholarly journals Impairment of Hypoxia-Induced CA IX by Beta-Blocker Propranolol—Impact on Progression and Metastatic Potential of Colorectal Cancer Cells

2020 ◽  
Vol 21 (22) ◽  
pp. 8760
Author(s):  
Monika Barathova ◽  
Katarina Grossmannova ◽  
Petra Belvoncikova ◽  
Veronika Kubasova ◽  
Veronika Simko ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Cells ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Metastatic Potential ◽  
Tumour Microenvironment ◽  
Beta Blockade ◽  
Multicellular Spheroids ◽  
Ca Ix ◽  
Colorectal Cancer Cells

The coexistence of cancer and other concomitant diseases is very frequent and has substantial implications for treatment decisions and outcomes. Beta-blockers, agents that block the beta-adrenergic receptors, have been related also to cancers. In the model of multicellular spheroids formed by colorectal cancer cells we described a crosstalk between beta-blockade by propranolol and tumour microenvironment. Non-selective beta-blocker propranolol decreased ability of tumour cells to adapt to hypoxia by reducing levels of HIF1α and carbonic anhydrase IX in 3D spheroids. We indicated a double action of propranolol in the tumour microenvironment by inhibiting the stability of HIF1α, thus mediating decrease of CA IX expression and, at the same time, by its possible effect on CA IX activity by decreasing the activity of protein kinase A (PKA). Moreover, the inhibition of β-adrenoreceptors by propranolol enhanced apoptosis, decreased number of mitochondria and lowered the amount of proteins involved in oxidative phosphorylation (V-ATP5A, IV-COX2, III-UQCRC2, II-SDHB, I-NDUFB8). Propranolol reduced metastatic potential, viability and proliferation of colorectal cancer cells cultivated in multicellular spheroids. To choose the right treatment strategy, it is extremely important to know how the treatment of concomitant diseases affects the superior microenvironment that is directly related to the efficiency of anti-cancer therapy

Safety of Esmolol in Patients with Acute Myocardial Infarction Treated with Thrombolytic Therapy Who Had Relative Contraindications to Beta-Blocker Therapy

1994 ◽  
Vol 28 (6) ◽  
pp. 701-703 ◽  
Author(s):  
Aryan N. Mooss ◽  
Daniel E. Hilleman ◽  
Syed M. Mohiuddin ◽  
Claire B. Hunter
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Adverse Effects ◽  
Thrombolytic Therapy ◽  
Dose Reduction ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Beta Blockade ◽  
Blocker Therapy ◽  
Beta Blocker Therapy

OBJECTIVE: This study was conducted to evaluate the safety of esmolol in 114 patients treated with thrombolytic therapy for acute myocardial infarction who also had relative contraindications to beta-blockade, and the predictive value of patient tolerance to esmolol and subsequent patient tolerance of oral beta-blocker therapy. PATIENTS: One hundred and fourteen patients with myocardial infarction documented by enzyme concentrations and electrocardiographic changes who also had relative contraindications to beta-blockade. METHODS: Esmolol was initiated during acute myocardial infarction for myocardial ischemia (n=88), hypertension (n=13), or supraventricular tachycardia (n=13). Relative contraindications to beta-blocker therapy included either active signs/symptoms of left ventricular dysfunction or a history of congestive heart failure (n=40), a history of chronic obstructive pulmonary disease or asthma (n=31), bradycardia (HR <60 beats/min; n=18), peripheral vascular disease (n=15), or hypotension (systolic BP <100 mm Hg; n=14). RESULTS: During initial esmolol dose titration, 69 patients tolerated 300 μg/kg/min, 12 patients tolerated 200 μg/kg/min, 17 patients tolerated 100 μg/kg/min, and 16 patients tolerated 50 μg/kg/min. Twenty-eight patients (25 percent) developed dose-limiting adverse effects during esmolol maintenance infusions. Sixteen patients required esmolol dose reduction and 12 required esmolol discontinuation. Adverse effects reversed within 30–45 minutes following dose reduction or discontinuation. The 86 patients who tolerated esmolol infusions without dose reduction or drug discontinuation were subsequently treated with oral beta-blockers. Eleven of these patients (13 percent) developed adverse effects requiring oral beta-blocker discontinuation. Nine of these patients had tolerated only 50 μg/kg/min of esmolol, and the other 2 patients had tolerated only 100 μg/kg/min. CONCLUSIONS: Esmolol can be used safely in most patients treated with thrombolytic therapy for acute myocardial infarction who have relative contraindications to beta-blockers. Tolerance to higher maintenance doses of esmolol is a good predictor of subsequent outcome with oral beta-blocker therapy.

scholarly journals Beta-blocker therapy in patients with COPD: a systematic literature review and meta-analysis with multiple treatment comparison

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Claudia Gulea ◽  
Rosita Zakeri ◽  
Vanessa Alderman ◽  
Alexander Morgan ◽  
Jack Ross ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Beta Blocker ◽  
Observational Studies ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Life Outcomes ◽  
Blocker Therapy ◽  
Beta Blocker Therapy

Abstract Background Beta-blockers are associated with reduced mortality in patients with cardiovascular disease but are often under prescribed in those with concomitant COPD, due to concerns regarding respiratory side-effects. We investigated the effects of beta-blockers on outcomes in patients with COPD and explored within-class differences between different agents. Methods We searched the Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline for observational studies and randomized controlled trials (RCTs) investigating the effects of beta-blocker exposure versus no exposure or placebo, in patients with COPD, with and without cardiovascular indications. A meta-analysis was performed to assess the association of beta-blocker therapy with acute exacerbations of COPD (AECOPD), and a network meta-analysis was conducted to investigate the effects of individual beta-blockers on FEV1. Mortality, all-cause hospitalization, and quality of life outcomes were narratively synthesized. Results We included 23 observational studies and 14 RCTs. In pooled observational data, beta-blocker therapy was associated with an overall reduced risk of AECOPD versus no therapy (HR 0.77, 95%CI 0.70 to 0.85). Among individual beta-blockers, only propranolol was associated with a relative reduction in FEV1 versus placebo, among 199 patients evaluated in RCTs. Narrative syntheses on mortality, all-cause hospitalization and quality of life outcomes indicated a high degree of heterogeneity in study design and patient characteristics but suggested no detrimental effects of beta-blocker therapy on these outcomes. Conclusion The class effect of beta-blockers remains generally positive in patients with COPD. Reduced rates of AECOPD, mortality, and improved quality of life were identified in observational studies, while propranolol was the only agent associated with a deterioration of lung function in RCTs.

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