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J Clin Anesth. 2008 Jun;20(4):284-9. doi: 10.1016/j.jclinane.2007.12.014.

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

Author information

1
Intensive Care Unit, Department of Surgery, Institute for Digestive System Diseases, Clinical Center of Serbia, 11000 Belgrade, Serbia. vemika@eunet.yu

Abstract

STUDY OBJECTIVE:

To analyze the clinical effectiveness of the beta-1-adrenergic 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.

PMID:
18617127
DOI:
10.1016/j.jclinane.2007.12.014
[Indexed for MEDLINE]
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