Vascular Surgery Patients Prescribed Preoperative 尾-Blockers Experienced a Decrease in the Maximal Heart Rate Observed During Induction of General Anesthesia

详细信息	查看全文 | 推荐本文 |

• 作者：Seshadri C. Mudumbai ; MD^鈦?/sup> ; ^&dagger ; ; ^{mudumbai@stanford.edu} ; Todd Wagner ; PhD^&Dagger ; ; Satish Mahajan ; RN ; BSN ; MEng^§ ; ; Robert King ; BS^鈭?/sup> ; Paul A. Heidenreich ; MD ; MS^¶ ; ; Mark Hlatky ; MD^# ; Arthur Wallace ; MD ; PhD^鈦庘亷 ; ^&dagger ; &dagger ; ; Edward R. Mariano ; MD ; MAS^鈦?/sup> ; ^&dagger ;
• 关键词：vascular surgery ; 尾-blockers ; heart rate ; general anesthesia ; perioperative outcome
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2012
• 期刊代码：163_10530770
• 类别：med
• 出版时间：June, 2012
• 卷：26
• 期：3
• 页码：414-419
• 文件大小：741 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferences

Objective

To investigate the association of preoperative 尾-blocker usage and maximal heart rates observed during the induction of general anesthesia.

Design

Retrospective descriptive, univariate, and multivariate analyses of electronic hospital and anesthesia medical records.

Setting

A tertiary-care medical center within the Veterans Health Administration.

Participants

Consecutive adult elective and emergent patients presenting for vascular surgery during calendar years 2005 to 2011.

Interventions

None.

Measurements and Main Results

Of the 430 eligible cases, 218 were prescribed 尾-blockers, and 212 were not taking 尾-blockers. The two groups were comparable across baseline patient factors (ie, demographic, morphometric, surgical duration, and surgical procedures) and induction medication doses. The 尾-blocker group experienced a lower maximal heart rate during the induction of general anesthesia compared with the non-尾-blocker group (105 卤 41 beats/min v 115 卤 45 beats/min, respectively; p < 0.01). Adjusted linear regression found a statistically significant association between lower maximal heart rate and the use of 尾-blockers (尾 = 鈭?1.1 beats/min, p < 0.01). There was no difference between groups in total intraoperative 尾-blocker administration.

Conclusions

Preoperative 尾-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 尾-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.