El betabloqueo en pacientes sometidos a cirugía no cardíaca ha sido ampliamente recomendado como una forma de disminuir los eventos adversos cardiovasculares durante el periodo perioperatorio. Sin embargo, los estudios han mostrado resultados discordantes. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos 22 revisiones sistemáticas que en conjunto incluyen 131 estudios, entre ellos 112 estudios aleatorizados. Extrajimos los datos, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso perioperatorio de betabloqueadores en pacientes sometidos a cirugía no cardíaca, si bien probablemente disminuye el riesgo de infarto miocárdico, aumenta el riesgo de accidente cerebrovascular y la mortalidad total.

Authors: Andrés Armstrong[1,2], Gabriel Rada[2,3,4,5,6], Fernando Altermatt[2,7]

Affiliation:
[1] Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[2] Proyecto Epistemonikos, Santiago, Chile
[3] Programa de Salud Basada en Evidencia, Facultad de Medicina, Pontificia Universidad Católica de Chile
[4] Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[5] GRADE working group
[6] The Cochrane Collaboration
[7] Departamento de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

E-mail: fernando.altermatt@gmail.com

Author address:
[1] Facultad de Medicina
Pontificia Universidad Católica de Chile
Lira 63
Santiago Centro
Chile

Citation: Armstrong A, Rada G, Altermatt F. Is perioperative beta-blockade effective and safe in patients undergoing non-cardiac surgery?. Medwave 2016; 16(Suppl5):e6819 doi: 10.5867/medwave.2016.6819

Publication date: 27/12/2016

PubMed record

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Sametz W, Metzler H, Gries M, Porta S, Sadjak A, Supanz S, et al. Perioperative catecholamine changes in cardiac risk patients. Eur J Clin Invest. 1999 Jul;29(7):582-7 | PubMed |

Parker SD, Breslow MJ, Frank SM, Rosenfeld BA, Norris EJ, Christopherson R, et al. Catecholamine and cortisol responses to lower extremity revascularization: correlation with outcome variables. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Crit Care Med. 1995 Dec;23(12):1954-61 | PubMed |

Priebe HJ. Triggers of perioperative myocardial ischaemia and infarction. Br J Anaesth. 2004 Jul;93(1):9-20 | PubMed |

Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990 Aug;73(2):308-27 | PubMed |

Angeli F, Verdecchia P, Karthikeyan G, Mazzotta G, Gentile G, Reboldi G. ß-Blockers reduce mortality in patients undergoing high-risk non-cardiac surgery. Am J Cardiovasc Drugs. 2010;10(4):247-59 | CrossRef | PubMed |

Angeli F, Verdecchia P, Karthikeyan G, Mazzotta G, Repaci S, del Pinto M, et al. Beta-blockers and risk of all-cause mortality in non-cardiac surgery. Ther Adv Cardiovasc Dis. 2010 Apr;4(2):109-18 | CrossRef | PubMed |

Auerbach AD, Goldman L. beta-Blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA. 2002 Mar 20;287(11):1435-44 | PubMed |

Bangalore S, Wetterslev J, Pranesh S, Sawhney S, Gluud C, Messerli FH. Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. Lancet. 2008 Dec 6;372(9654):1962-76 | CrossRef | PubMed |

Bouri S, Shun-Shin MJ, Cole GD, Mayet J, Francis DP. Meta-analysis of secure randomised controlled trials of ß-blockade to prevent perioperative death in non-cardiac surgery. Heart. 2014 Mar;100(6):456-64 | CrossRef | PubMed |

Dai N, Xu D, Zhang J, Wei Y, Li W, Fan B, et al. Different ß-blockers and initiation time in patients undergoing noncardiac surgery: a meta-analysis. Am J Med Sci. 2014 Mar;347(3):235-44 | CrossRef | PubMed |

Devereaux PJ, Beattie WS, Choi PT, Badner NH, Guyatt GH, Villar JC, et al. How strong is the evidence for the use of perioperative beta blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. BMJ. 2005 Aug 6;331(7512):313-21 | PubMed |

Schouten O, Shaw LJ, Boersma E, Bax JJ, Kertai MD, Feringa HH, et al. A meta-analysis of safety and effectiveness of perioperative beta-blocker use for the prevention of cardiac events in different types of noncardiac surgery. Coron Artery Dis. 2006 Mar;17(2):173-9 | PubMed |

Giles JW, Sear JW, Foëx P. Effect of chronic beta-blockade on peri-operative outcome in patients undergoing non-cardiac surgery: an analysis of observational and case control studies. Anaesthesia. 2004 Jun;59(6):574-83 | PubMed |

Guay J, Ochroch EA. ß-blocking agents for surgery: influence on mortality and major outcomes. A meta-analysis. J Cardiothorac Vasc Anesth. 2013 Oct;27(5):834-44 | CrossRef | PubMed |

Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity. Cochrane Database Syst Rev. 2014 Sep 18;(9):CD004476 | CrossRef | PubMed |

Landoni G, Turi S, Biondi-Zoccai G, Bignami E, Testa V, Belloni I, et al. Esmolol reduces perioperative ischemia in noncardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth. 2010 Apr;24(2):219-29 | CrossRef | PubMed |

McGory ML, Maggard MA, Ko CY. A meta-analysis of perioperative beta blockade: what is the actual risk reduction? Surgery. 2005 Aug;138(2):171-9 | PubMed |

Mostafaie K, Bedenis R, Harrington D. Beta-adrenergic blockers for perioperative cardiac risk reduction in people undergoing vascular surgery. Cochrane Database Syst Rev. 2015 Jan 14;1:CD006342 | CrossRef | PubMed |

Riber LP, Larsen TB, Christensen TD. Postoperative atrial fibrillation prophylaxis after lung surgery: systematic review and meta-analysis. Ann Thorac Surg. 2014 Dec;98(6):1989-97 | CrossRef | PubMed |

Sedrakyan A, Treasure T, Browne J, Krumholz H, Sharpin C, van der Meulen J. Pharmacologic prophylaxis for postoperative atrial tachyarrhythmia in general thoracic surgery: evidence from randomized clinical trials. J Thorac Cardiovasc Surg. 2005 May;129(5):997-1005 | PubMed |

Stevens RD, Burri H, Tramèr MR. Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg. 2003 Sep;97(3):623-33 | PubMed |

Talati R, Reinhart KM, White CM, Phung OJ, Sedrakyan A, Kluger J, et al. Outcomes of perioperative beta-blockade in patients undergoing noncardiac surgery: a meta-analysis. Ann Pharmacother. 2009 Jul;43(7):1181-8 | CrossRef | PubMed |

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