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Betablocker perioperative

Stefanie Schwarz, Alain M Bernheim
The preoperative cardiovascular risk management accounts for patient-related risk factors, the circumstances leading to the surgical procedure, and the risk of the operation. While urgent operations should not be delayed for cardiac testing, an elective surgical intervention should be postponed in unstable cardiac conditions. In stable cardiac situations, prophylactic coronary interventions to reduce the risk of perioperative complications are rarely indicated. Therefore, in most cases, the planned operation can be performed without previous cardiac stress testing or coronary angiography...
May 6, 2015: Praxis
Jaromír Hradec
Betablockers are one of the most successful drug classes in cardiology. They have many indications - starting with treatment of arterial hypertension, continuing with secondary prevention post myocardial infarction up to the treatment of heart failure with reduced ejection fraction. Recently, many analysis and information were published which are questioning yet unshakable role of betablockers in some cardiovascular diagnosis. This review article summarizes the controversies, which have accumulated around betablockers in the treatment of hypertension, secondary prevention of coronary artery disease, perioperative administration in patients undegoing non-cardiac surgery and treatment of heart failure with reduced ejection fraction...
May 2015: Vnitr̆ní Lékar̆ství
Alvaro D B Bordalo, Angelo L Nobre, Fernanda Silva, Carlos Serpa, João Cravino
UNLABELLED: In spite of the strong criticism elicited thereafter, the results of a multicentric study on the consequences of several perioperative anti-hemorrhagic strategies in cardiac surgery, published five years ago, led to the aprotinin (Aprot) withdrawal from the market and its progressive replacement by tranexamic acid (TrAc) in many surgical departments. OBJECTIVE: To evaluate the hemostatic effects and clinical consequences of TrAc use or non-use in off-pump coronary bypass surgery (CABG) and compare them with those of Aprot use or non-use in conventional (conv) CABG...
July 2011: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Martin Balik, Jan Rulisek, Pavel Leden, Michal Zakharchenko, Michal Otahal, Hana Bartakova, Josef Korinek
BACKGROUND: Betablockade has been shown to have cardioprotective effects in patients under perioperative stress. Besides animal model of septic shock and a small cohort of septic patients, these benefits have not been studied in septic shock patients who require norepinephrine administration. METHODS: After correction of preload, an esmolol bolus (0.2-0.5 mg/kg) followed by continuous 24 h infusion was administered in septic patients with sinus or supraventricular tachycardia (HR > 120/min)...
August 2012: Wiener Klinische Wochenschrift
Alvaro Bordalo, Angelo Nobre, Ricardo Pereira, Alberto Lemos, Mário Mendes, Filipe Pereira, Carlos Serpa, João Cravino
UNLABELLED: Perioperative myocardial infarction ( POMI ) in cardiac surgery is an issue that deserves to be revisited. OBJECTIVE: To evaluate the risk factors, clinical characteristics and prognosis of POMI in high-risk patients ( pts ) undergoing coronary bypass surgery ( CABG ). MATERIAL AND METHODS: Retrospective study of 694 pts undergoing isolated CABG - 252 pts with conventional CABG and 442 pts with off-pump CABG - and operated on by 4 surgeons largely experienced in both CABG modalities...
January 2011: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Stefano Urbinati, Pompilio Faggiano, Furio Colivicchi, Carmine Riccio, Maurizio Giuseppe Abrignani, Alberto Genovesi-Ebert, Francesco Fattirolli, Stefania De Feo, Simona Gambetti, Massimo Uguccioni
A standardized and evidence-based approach to the cardiological management of patients undergoing noncardiac surgery has been recently defined by Task Forces of the American Heart Association (AHA), American College of Cardiology (ACC) and the European Society of Cardiology (ESC) that published their guidelines in 2007 and 2009, respectively. Both the recommendations moved from risk indices to a practical, stepwise approach of the patient, which integrates clinical risk factors and test results with the estimated stress of the planned surgical procedure...
September 2011: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Paulo M Pêgo-Fernandes, Luiz Felipe P Moreira, Germano Emílio C Souza, Fernando Bacal, Edimar Alcides Bocchi, Noedir Antônio G Stolf, Fábio Biscegli Jatene
BACKGROUND: The level of sympathetic nervous activity is a major determinant of prognosis in patients with heart failure. OBJECTIVE: The purpose of this investigation was to perform a proof-of-principle trial of therapeutic endoscopic left thoracic sympathetic blockade in heart failure patients to assess safety and immediate effects. METHODS: Fifteen patients with dilated cardiomyopathy and left ventricular ejection fraction (LVEF) < 40%, New York Heart Association functional class II or III, and heart rate > 65 bpm, despite either adequate betablocker use or intolerant to it, were enrolled...
December 2010: Arquivos Brasileiros de Cardiologia
Luminita Iliuta, Ruxandra Christodorescu, Daniela Filpescu, Horatiu Moldovan, Bogdan Radulescu, Rasvan Vasile
In this study, we tried to compare the efficacy and safety of betaxolol vs. metoprolol immediately postoperatively in coronary artery bypass grafting (CABG) patients and to determine whether prophylaxy for atrial fibrillation (AF) with betaxolol could reduce hospitalization and economic costs after cardiac surgery. Our trial was open-label, randomized, multicentric enrolling 1352 coronary surgery patients randomized to receive betaxolol or metoprolol. The primary endpoints were the composites of 30-day mortality, in-hospital AF (safety endpoints), duration of hospitalization and immobilization, quality of life, and the above endpoint plus in-hospital embolic event, bradycardia, gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy plus safety endpoint)...
July 2009: Interactive Cardiovascular and Thoracic Surgery
Vincent Piriou
Noninvasive stress tests such as myocardial perfusion scintigraphy or dobutamine stress echography have to be performed, only if they modify the perioperative strategy. Prophylactic pre-operative coronary revascularization can be helpful only in selected cases, independently from the operative context. Coronary stenting in patients undergoing noncardiac surgery (bare metal stent or drug-eluting stents) adds an additional risk related to antiplatelet therapy management. Preoperative medical therapy optimisation is based on betablockers, and probably statins...
July 2009: La Presse Médicale
Alexander Jc Mittnacht, Michael Fanshawe, Steven Konstadt
Valvular heart disease can be an important finding in patients presenting for noncardiac surgery. Valvular heart disease and resulting comorbidity, such as heart failure or atrial fibrillation, significantly increase the risk for perioperative adverse events. Appropriate preoperative assessment, adequate perioperative monitoring, and early intervention, should hemodynamic disturbances occur, may help prevent adverse events and improve patient outcome. This review article aims to guide the practitioner in the various aspects of anesthetic management in the perioperative care of patients with valvular heart disease...
March 2008: Seminars in Cardiothoracic and Vascular Anesthesia
V Piriou, E Marret, P Albaladejo, E Samain
No abstract text is available yet for this article.
March 2008: Annales Françaises D'anesthèsie et de Rèanimation
Kumar Rajamani, Seemant Chaturvedi
The last 15 years have witnessed a resurgence of the role of surgical options for prevention of ischemic stroke. The landmark randomized trials including NASCET and ECST were published and explored the role of carotid endarterectomy in this regard. Patients with high grade stenosis of the internal carotid artery (> or = 70%) with prior TIA or minor non disabling stroke in the same territory were shown to have significant benefit of the procedure compared to best medical treatment. Benefit was comparatively less in patients with moderate grade stenosis of the ICA (50-69%)...
July 2007: Current Drug Targets
E Marret, N Lembert, F Bonnet
OBJECTIVES: Patient scheduled for infrarenal abdominal aortic aneurysm surgery carries a high risk of cardiac or respiratory comorbidity. To outline the perioperative management for these patients. METHODS: Review of the literature using MesH Terms "abdominal aortic aneurysm", "anesthesia", "analgesia" "critical care" and/or "surgery" in Medline database. RESULTS: Cardiac preoperative evaluation and management have recently been reviewed. Intermediate and high-risk patients should undergo non-invasive cardiac testing to decide between a preoperative medical strategy (using betablocker+/-statin and aspirin) and an interventional strategy (coronary angioplasty or cardiac surgery)...
February 2006: Annales Françaises D'anesthèsie et de Rèanimation
C Wunderlich, G Gossrau, E Wunderlich, E Altmann
INTRODUCTION: Cardiovascular complications remain the principal cause of both morbidity and mortality after major vascular surgery. The well-known coincidence between vascular disease and coronary artery disease provided the rationale for a detailed analysis of major perioperative cardiovascular complications in their relation to preoperative and intraoperative parameter METHODS AND PATIENTS: 90 patients scheduled to undergo either femoral-popliteal bypass (n = 74) or repair of an infrarenal aortic aneurysm (n = 16) were prospectively included in the study...
February 2005: VASA. Zeitschrift Für Gefässkrankheiten
N Danton, J P Viale, P Y Gueugniaud, J J Lehot, V Piriou
OBJECTIVES: To evaluate the anaesthesiologists' attitude concerning the perioperative administration of betablockers (BB), especially prophylactic BB, in order to prevent postoperative cardiac complications. METHODS: A questionnaire including 20 items was sent to 700 anaesthesiologists of 4 French departments (Ain, Isere, Loire et Rhone). RESULTS: The response rate was 30%. Eighty-eight percent of respondents prescribed the BB with the premedication, on the day of the surgery in patients who were on regular BB...
November 2004: Annales Françaises D'anesthèsie et de Rèanimation
T Geeraerts, P Albaladejo, H Beloeil, A Wernet, R Bocquet, Y Castier, J Marty
OBJECTIVE: The aim of this study was to evaluate betablockers use and effect in the preoperative period in vascular and thoracic surgery. PATIENTS AND METHODS: Retrospective study concerning patients scheduled for high or intermediate surgical risk procedure (n = 321) in a French vascular and thoracic surgery department during 2002. Eligibility for betablocker therapy was defined as previously described for inclusion criteria in Mangano's Study (N Engl J Med 1996;335:1713-20)...
August 2004: Annales Françaises D'anesthèsie et de Rèanimation
J Jung, J U Schreiber
Cardiovascular diseases including heart failure represent a common disease in patients referred for anesthesia. In most cases, heart failure is caused by left ventricular dysfunction due to coronary heart disease. The aims of the treatment of chronic heart failure are the relief of symptoms, the improvement of prognosis and the prevention of the progression of heart failure. The first-line treatment involves the underlying heart disease such as myocardial revascularisation procedures in coronary heart disease or the correction of valve diseases...
July 2003: Der Anaesthesist
M Bory
The assessment of results of medical treatment, angioplasty and coronary bypass surgery in diabetic coronary patients is difficult because of the absence of distinction in the subgroups of type 1 and 2 diabetes and of stable and unstable angina. With respect to medical therapy, betablockers are practically without deleterious effects and are effective in diabetic populations. The same is true of other antianginal drugs. Conventional coronary angioplasty is associated with poorer results than the general population in the long-term, partly because of progression of the coronary artery disease and partly because of an increased incidence of restenosis...
December 2000: Archives des Maladies du Coeur et des Vaisseaux
M P Gandolfini, A M Lefrançois, I Pannier-Moreau, A Guiomard
The authors report an original case of the association of three pathologies: pheochromocytoma, hyperthyroidism and cardiomyopathy with left ventricular outflow tract obstruction. This type of cardiac disease has occasionally been described in cases of pheochromocytoma and are usually induced by the endocrine disturbance because they regress with treatment of the pheochromocytoma. The associated hyperthyroidism observed in this case is very rare and may have increased the left ventricular pressure gradient. Medical treatment before surgery of the pheochromocytoma was unusual in that a triple therapy was used including betablockers, classically contra-indicated in pheochromocytoma alone...
December 1998: Archives des Maladies du Coeur et des Vaisseaux
P Coriat, D Eyraud
The frequency, the nature and physiopathological mechanisms of cardiac complications of general surgical patients are well known. Acute myocardial infarction, the main complication, occurs in 3 to 5% of high risk cases. Though usually subendocardial and asymptomatic, it jeopardizes short and medium term survival of patients. It occurs in the first 48 hours after surgery in the majority of cases, the diagnosis being confirmed by increased serum troponine I levels. The circulatory, mechanical and inflammatory changes and hypercoagulability, which are present during the perioperative period, interact, disturbing the energetic equilibrium of the myocardium and causing episodes of myocardial ischaemia which, if prolonged, result in necrosis of the subendocardial myocardium...
August 1998: Archives des Maladies du Coeur et des Vaisseaux
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