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Anesth Analg 1987; 66:637-642
© 1987 International Anesthesia Research Society
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Comparison of Hemodynamic Responses to Isoproterenol Infusion and Surgical Stress in Patients Given Cardioselective and Noncardioselective ß-Adrenergic Antagonists

N. de Bruijn, MD, J. G. Reves, MD, N. Croughwell, CRNA, and K. Knopes, MD

Received from the Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North Carolina. Address correspondence to Dr. de Bruijn, Box 3094, Duke University Medical Center, Durham, NC 27710.

Abstract

Recent studies have demonstrated the presence of physiologically active ß2 receptors in the myocardium. We hypothesized that activation of cardiac ß2 receptors by endogenously released epinephrine and norepinephrine during surgical stress would add to the positive chronotropic response mediated by ß1 stimulation. Twenty patients scheduled for coronary artery bypass grafting were studied. Ten patients received a ß1-selective antagonist (atenolol, 6; metoprolol, 4) and ten patients received a nonselective ß1 and ß2 antagonist (propranolol) preoperatively. An isoproterenol dose-heart rate response test was performed. After stabilization, general anesthesia was induced followed by tracheal intubation and surgery. Hemodynamic data were recorded before induction, 1 min after induction, 5 min after intubation, I min before and after skin incision, 1 min before and after sternotomy. The ten patients on cardioselective ß-blocker drugs had significantly greater increases in heart rate during isoproterenol administration than did the noncardioselectively blocked group of patients. Heart rate responses to tracheal intubation and surgical stress were not significantly different between the two groups at any point. We conclude that changes in heart rate during perioperative stress are primarily mediated through activation of ß1 receptors in the myocardium and that patients on either cardioselective or noncardioselective ß-blockers have similar protection to adrenergic-mediated stressful hemodynamic events.

Key Words: HEART—ß-adrenoceptor blockade. • SYMPATHETIC NERVOUS SYSTEM—adrenergic blockade. • ANESTHESIA—cardiovascular.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1987 by the International Anesthesia Research Society.