Significance of beta-blocking agents in perioperative medicine. Part Two: Therapeutic indications

Purpose: To review the pharmacologic and pathophysiologic information neces sary to prescribe beta-blockers (BB) in perioperative medicine. Data source: Manual retrieval and electronic research of the literature usi ng MEDLINE (key-words: anesthesia and beta- blocker; surgery and beta-block er). Data synthesis: In non cardiac surgery, the beneficial effects of BB have b een demontrated in hypertensive patients since 1979. In 1996, the beneficia l effects of atenolol in patients with coronary artery disease (reduction o f postoperative myocardial ischemia and overall reduction in two-year morta lity) were demonstrated, in coronary surgery, the interest of preoperative BB treatment has been shown since 1983. Administration of BB has been shown to be beneficial in acute myocardial infarction or chronic cardiac failure (except in NYHA class IV patients). Conclusion: BB have been shown to exert a beneficial effect on postoperativ e outcomes in patients with cardiovascular disease or risk factors, and the ir more widespread use in perioperative medicine is encouraged.