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Anesthesiology. 2010 Sep;113(3):585-92. doi: 10.1097/ALN.0b013e3181e73eea.

Variations in pharmacology of beta-blockers may contribute to heterogeneous results in trials of perioperative beta-blockade.

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  • 1Department of Medicine, University of Texas Health Science Center at San Antonio, and Audie L. Murphy Memorial Veterans Affairs Hospital, San Antonio, Texas, USA. rbadgett@kumc.edu



Randomized controlled trials and meta-analyses provide conflicting guidance on the role of beta-adrenergic receptor blockers (beta-blockers) in reducing perioperative complications. We hypothesize that variability in trial results may be due in part to heterogeneous properties of beta-blockers. First, we propose that the extent of beta-blocker metabolism by cytochrome P-450 and the time available to titrate the dosage before surgery (titration time) may interact; dependence on P-450 may be most harmful when titration time is short. Second, beta-blockers vary in their selectivity for the beta-1 receptor and reduced selectivity may contribute to cerebral ischemia.


We used meta-analysis and meta-regression of existing trials to explore the role of these pharmacological properties.


We found that both of these pharmacological factors are significantly associated with reduced efficacy of beta-blockers.


Pharmacological properties of beta-blockers may contribute to heterogeneous trial results. Many trials have used metoprolol, which is extensively metabolized by cytochrome P450 and is less selective for the beta-1 receptor. For these two reasons, the efficacy of metoprolol to prevent perioperative cardiac complications should be compared with the efficacy of other beta-blockers.

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