Original contribution
The effect of metoprolol on perioperative outcome in coronary patients undergoing nonvascular abdominal surgery

https://doi.org/10.1016/j.jclinane.2007.12.014Get rights and content

Abstract

Study Objective

To analyze the clinical effectiveness of the β-1-aderenergic blocker, metoprolol.

Design

Prospective, observational, clinical study.

Setting

Operating room and intensive care unit of a tertiary-care teaching hospital.

Patients

111 ASA physical status II, III, and IV consecutive patients who were scheduled for open abdominal nonvascular surgery.

Interventions

Patients were divided into two stratification groups: 83 (74.8%) of 111 received metoprolol, and 28 (25.2%) of 111 were controls. Within 24 to 96 hours, the drug was used parenterally in a dose of 5, 10, and 15 mg per 24 hours. Metoprolol cardioprotection was applied during the whole perioperative period, in the form of tablets in a dose of 25, 50, and 100 mg per 24 hours until the 30th postoperative day.

Measurements

During surgery, and in the first 72 postoperative hours, patients were monitored by continuous ST-T segment monitoring. A 12-lead electrocardiogram was attached immediately after surgery; on postoperative days 1, 2, and 7; and one day before discharge from the hospital. Serum troponin-T level was controlled 6, 24, and 96 hours after surgery.

Main Results

Postoperative mortality of cardiac etiology after 30 days of surgery was 1.2% (1/83) in the metoprolol group versus 7.1% (2/28) in the nonmetoprolol group (P < 0.05). The causes of death in these three patients were acute myocardial infarction, congestive heart failure, and malignant arrhythmias.

Conclusions

Perioperative cardioprotection significantly reduced mortality until postoperative day 30 in patients having open abdominal nonvascular surgery with general anesthesia.

Introduction

Many studies have analyzed the prophylactic use of β-blockers as part of a strategy of cardiac risk reduction in patients undergoing noncardiac surgery [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26]. Guidelines support β-blocker treatment in high-risk cardiac patients undergoing major noncardiac surgery [27], [28], [29], [30].

The goal of our prospective, observational clinical study was to analyze the clinical effectiveness of our original cardioprotective protocol using the cardioselective β-1-aderenergic blocker, metoprolol, applied for the first time in our patients with angiographically verified coronary artery disease (CAD), having undergone open abdominal nonvascular surgery during general anesthesia.

Section snippets

Materials and methods

We conducted a prospective study of 111 consecutive patients, who were operated on at the Department of Digestive Surgery, Institute of Digestive System Diseases, University Clinical Center of Serbia in Belgrade, Serbia, from July 2002 to December 2003. Enrollment criterion was angiographically verified CAD.

All patients from the selected group underwent coronary angiography in the preoperative, prehospital period, independent of noncardiac surgery along with cardiosurgical consultation. The

Results

Two stratification groups of coronary patients were compared: 83 (74.8%) of 111 covered by metoprolol, and 28 (25.2%) of 111 without metoprolol. The group of patients with metoprolol therapy had a lower percentage of all expected cardiac complications compared with the group without metoprolol. Postoperative mortality of cardiac etiology to the 30th postoperative day was 1.2% (1/83) in the metoprolol group versus 7.1% (2/28) in the nonmetoprolol group (P < 0.05).

The study also found a

Discussion

Our prospective, observational, clinical study included 111 consecutive patients with angiographically verified CAD, undergoing open abdominal nonvascular surgery during general anesthesia.

The clinical effectiveness of the cardioselective β-1-adrenergic blocker, metoprolol, in the frequency of perioperative cardiac complications was analyzed, and its positive cardioprotective effect was confirmed.

Perioperative cardiac complications were monitored at all times in both study groups. It was

Conclusion

Postoperative mortality of cardiac etiology up to postoperative day 30 was 1.2% (1/83) in the metoprolol group versus 7.1% (2/28) in the nonmetoprolol group.

Perioperative cardioprotection by our therapeutical protocol with the cardioselective β-1-adrenergic blocker, metoprolol, significantly reduced mortality up to postoperative day 30 in coronary patients having undergone open abdominal nonvascular surgery during general anesthesia.

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