Objective: To determine the impact of perioperative β-adrenergic receptor (βAR) 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 βAR antagonist-blocking drugs in the perioperative period, including during operation, and (2) patients not given βAR antagonists. Measurements and Main Results: βAR 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 βAR antagonist therapy, and 279 (11%) did not. Adverse neurologic events occurred in 3.9% (n = 90) of patients who received perioperative βAR antagonists and 8.2% (n = 23) of patients who did not receive βAR 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 βAR antagonists and 4.3% (n = 12) of patients who did not receive βAR antagonists (odds ratio, 0.43; 95% confidence interval, 0.23 to 0.83; p = 0.016). Conclusion: Use of β-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.
|Number of pages||8|
|Journal||Journal of Cardiothoracic and Vascular Anesthesia|
|State||Published - 2002|
Bibliographical noteFunding Information:
Supported by NIH grants RO1-AG09663 (J.G.R.), 1RO1-HL54316 (M.F.N.), RO1-HL57447 (D.A.S.), KO2-AG00545 (D.A.S.), #HL57447 (D.A.S.), and AG00745 (D.A.S.), American Heart Association Grant-In-Aid, #95010970 (M.F.N.), and NIH MOI-RR-30.
- Cardiac surgical procedures
- Coronary artery bypass graft (CABG) surgery
- Neurologic complications
- Transient ischemic attack (TIA)
- β-adrenergic blockers
- β-adrenergic receptor (βAR)
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Anesthesiology and Pain Medicine