Perioperative use of beta-adrenergic antagonists and anemia: known knowns, known unknowns, unknown unknowns; and Unknown Knowns.

摘要

In seminal publications, Mangano et al. demonstrated an association of postoperative tachycardia and myocardial ischemia in patients with or at risk for coronary artery disease, after surgery other than cardiac surgery, after having previously shown an association between postoperative ischemia and adverse cardiac outcomes. Thus, a link was established for postoperative tachycardia, myocardial ischemia, and adverse outcomes. That group followed with a logical extension of their work, showing in a prospective, randomized, double-blinded, but relatively small trial of 200 patients, with or at risk for arteriosclerotic coronary artery disease, undergoing surgery other than cardiac surgery, that administration of a beta-adrenergic antagonist begun immediately before surgery and continued for the first of 7 days or hospital discharge decreased postoperative myocardial ischemia, and long-term (2-yr) mortality. The former publication was accompanied by an editorial by Warltier, decrying the underutilization of beta-adrenergic antagonists.