Impact of perioperative bleeding on the protective effect of ß-blockers during infrarenal aortic reconstruction.
Anesthesiology
; 117(6): 1203-11, 2012 Dec.
Article
em En
| MEDLINE
| ID: mdl-22652895
ABSTRACT
BACKGROUND:
The use of ß-blockers during the perioperative period remains controversial. Although some studies have demonstrated their protective effects regarding postoperative cardiac complications, others have demonstrated increased mortality when ß-blockers were introduced before surgery.METHODS:
In this observational study involving 1,801 patients undergoing aortic reconstruction, we prospectively assessed ß-blocker therapy compared with no ß-blocker therapy, with regard to cardiac and noncardiac postoperative outcomes using a propensity score approach. The impact of ß-blockers was analyzed according to the intraoperative bleeding estimated by transfusion requirements.RESULTS:
In-hospital mortality was 2.5% (n=45), ß-blocker use was associated with a reduced frequency of postoperative myocardial infarction (OR=0.46, 95% CI [0.26; 0.80]) and myocardial necrosis (OR=0.62, 95% CI [0.43; 0.88]) in all patients, but also with an increased frequency of multiple organ dysfunction syndromes (OR=2.78, 95% CI [1.71; 4.61]). In patients with severe bleeding (n=163; 9.1%), the frequency of in-hospital death (OR=6.65, 95% CI [1.09; 129]) and/or multiple organ dysfunction syndromes (OR=4.18, 95% CI [1.81; 10.38]) were markedly increased. Furthermore, no more than 28% of the patients who died presented with postoperative myocardial infarction, whereas 69% of the patient with a postoperative myocardial infarction also presented an excessive bleeding.CONCLUSIONS:
Perioperative ß-blocker therapy was associated with an overall reduction in postoperative cardiac events. In the vast majority of patients with low perioperative bleeding, the global effect of ß-blockers was protective; in contrast, patients given ß-blockers who experienced severe bleeding had higher mortality and an increased frequency of multiorgan dysfunction syndrome.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Aorta Abdominal
/
Perda Sanguínea Cirúrgica
/
Antagonistas Adrenérgicos beta
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Assistência Perioperatória
/
Injúria Renal Aguda
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Anesthesiology
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
França