Neuroprotection is associated with β-adrenergic receptor antagonists during cardiac surgery:: Evidence from 2,575 patients

被引:33
作者
Amory, DW
Grigore, A
Amory, JK
Gerhardt, MA
White, WD
Smith, PK
Schwinn, DA
Reves, JG
Newman, MF
机构
[1] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27710 USA
[2] Duke Univ, Ctr Heart, Dept Anesthesiol, Div Cardiothorac Anesthesiol, Durham, NC USA
[3] Univ Washington, Dept Med, Seattle, WA USA
[4] Ohio State Univ, Med Ctr, Dept Anesthesiol, Columbus, OH 43210 USA
[5] Med Univ S Carolina, Dept Anesthesiol, Charleston, SC 29425 USA
关键词
beta-adrenergic blockers; beta-adrenergic receptor (beta AR); cardiac surgical procedures; coronary artery bypass; graft (CABG) surgery; neurologic complications; neuroprotection; stroke; coma; transient ischemic attack (TIA);
D O I
10.1053/jcan.2002.124132
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objective: To determine the impact of perioperative P-adrenergic receptor (betaAR) antagonist administration on neurologic complications. Design: Observational database analysis. Setting: A clinical investigation at a single tertiary academic medical center. Participants: Elective coronary artery bypass graft surgical patients operated on in the period 1994-1996. Interventions: Patients were divided into 2 groups: (1) patients given betaAR antagonist-blocking drugs in the perioperative period, including during operation, and (2) patients not given betaAR antagonists. Measurements and Main Results: betaAR antagonist use in 2,575 consecutive patients undergoing coronary artery bypass graft surgery (1994-1996) was determined using the Cardiovascular Database and Anesthesia Information System Database. Outcome variables were postoperative stroke, coma, and transient ischemic attack. Of patients, 113 (4.4%) had postoperative neurologic complications, including stroke (n = 44), coma (n = 12), and transient ischemic attack (n = 3). Of patients, 2,296 (89%) received perioperative betaAR antagonist therapy, and 279 (11%) did not. Adverse neurologic events occurred in 3.9% (n = 90) of patients who received perioperative betaAR antagonists and 8.2% (n = 23) of patients who did not receive betaAR antagonists (odds ratio, 0.45; 95% confidence interval, 0.28 to 0.73; p = 0.003, unadjusted.) Severe neurologic outcomes (stroke and coma) occurred in 1.9% (n = 44) of patients who received betaAR antagonists and 4.3% (n = 12) of patients who did not receive betaAR antagonists (odds ratio, 0.43; 95% confidence interval, 0.23 to 0.83; p = 0.016). Conclusion: Use of beta-adrenergic antagonists was associated with a substantial reduction in the incidence of postoperative neurologic complications. A prospective randomized trial is needed to verify this potentially important neuroprotective strategy in cardiac surgery. Copyright 2002, Elsevier Science (USA). All rights reserved.
引用
收藏
页码:270 / 277
页数:8
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