The Pharmaceutical Journal
Vol 268 No 7204 p895-899
29 June 2002

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Journal of Cardiothoracic and Vascular Anesthesia (more)

b-Blockers during surgery protect against stroke

Patients undergoing coronary artery bypass surgery who are given beta-blockers before or during their operation have a much lower risk of developing stroke or coma than those not given the drugs.

The findings come from a retrospective study of 2,575 patients who underwent bypass surgery at Duke University Medical Centre, North Carolina, during a three-year period. Overall, 3.9 per cent of patients who received beta-blockers suffered adverse neurological events, including stroke, coma, transient ischaemic attacks and encephalopathy, compared with 8.2 per cent of patients who were not given beta-blockers.

The study controlled for several risk factors, including severity of disease, age and the presence of diabetes. Even after controlling for these factors, a clinically significant benefit from beta-blocker use before or during surgery emerged.

Dr Mark Newman, chairman of anaesthesiology at Duke, said that nearly all bypass patients except for those whose heart was working at 20 per cent of its output should receive beta-blockers. He advocated intravenous administration during surgery in order to maintain optimal levels.

Dr Simon Stacey, anaesthetist at the London Chest Hospital, said: "In terms of standard practice, what I see in the anaesthetic room is that most people who should be on a beta-blocker are usually already on one to control their angina." But he added that advocating intravenous beta-blockers was not yet established practice in the United Kingdom. The study is published in the June issue of the Journal of Cardiothoracic and Vascular Anesthesia (2002;16:270).