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Intérêt des bêta-bloquants en médecine périopératoire. Deuxième partie: indications thérapeutiques

Service d'Anesthésie-Réanimation, Hôpital Cardiovasculaire & Pneumologique L. Pradel, B.P. Lyon Montchat - 69394 Lyon Cedex 03, France. Phone: 33-4-72-11-89-33; Fax: 33-4-72-35-73-14; E-mail: lehot{at}cismsun.univ-lyon1.fr

Purpose: To review the pharmacologic and pathophysiologic information necessary to prescribe beta-blockers (BB) in perioperative medicine.

Data source: Manual retrieval and electronic research of the literature using MEDLINE (key-words: anesthesia and beta-blocker; surgery and beta-blocker).

Data synthesis: In non cardiac surgery, the beneficial effects of BB have been demontrated in hypertensive patients since 1979. In 1996, the beneficial effects of atenolol in patients with coronary artery disease (reduction of postoperative myocardial ischemia and overall reduction in two-year mortality) 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 postoperative outcomes in patients with cardiovascular disease or risk factors, and their more widespread use in perioperative medicine is encouraged.