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Acute peri-operative beta blockade in intermediate-risk patients.
Biccard, B M; Sear, J W; Foëx, P.
Afiliación
  • Biccard BM; Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford, UK. bruce.biccard@nda.ox.ac.uk
Anaesthesia ; 61(10): 924-31, 2006 Oct.
Article en En | MEDLINE | ID: mdl-16978304
Peri-operative beta-blockade has been shown to reduce the incidence of postoperative cardio- vascular complications including cardiac death in high-risk non-cardiac surgical patients. However, the recent analysis by Lindenauer et al. suggests that it is inappropriate to administer beta-blockers blindly to all surgical patients. In an attempt to determine the appropriateness of peri-operative beta-blocker administration across patients with a spectrum of cardiovascular risks, we have examined studies of intermediate-risk patient groups (that is those undergoing intermediate risk surgery or those with a Lee Revised Cardiac Risk Score of < or =2). We analysed data from randomised prospective studies of the effects of acute peri-operative beta-blockade on the incidence of peri-operative myocardial ischaemia. By examining the demographics and surgical interventions in these patients, we have compared these studies with other studies of peri-operative silent myocardial ischaemia representing patients of similar risk. We thus estimated the expected long-term postoperative cardiovascular complication rate associated with myocardial ischaemia in these patients in terms of number needed to treat for ischaemia prevention and for prevention of major cardiovascular complications. Prevention of peri-operative myocardial ischaemia with acute beta-blockade in non-cardiac surgical patients with 1-2 RCRI clinical risk factors can be achieved with a number needed to treat of 10. It is not associated with a significant increase in drug associated side-effects. However, acute beta-blockade shows no real benefit in the prevention of major cardiovascular complications in intermediate risk non-vascular surgical patients with a number-needed-to-treat of 833. Vascular surgical patients undergoing intermediate-risk surgery may benefit from the protective effects of acute peri-operative beta-blockade, however, with a number-needed-to-treat of 68 it would require a randomised clinical trial of over 24,000 patients to prove their efficacy.
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Isquemia Miocárdica / Antagonistas Adrenérgicos beta / Atención Perioperativa Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Anaesthesia Año: 2006 Tipo del documento: Article Pais de publicación: Reino Unido
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Isquemia Miocárdica / Antagonistas Adrenérgicos beta / Atención Perioperativa Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Anaesthesia Año: 2006 Tipo del documento: Article Pais de publicación: Reino Unido