Poveda-Jaramillo Ricardo, Monaco Fabrizio, Zangrillo Alberto, Landoni Giovanni
Cardiovascular Anesthesia, University CES, Medellin, Colombia; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Cardiothorac Vasc Anesth. 2018 Jun;32(3):1415-1425. doi: 10.1053/j.jvca.2017.11.039. Epub 2017 Nov 23.
β-Blockers are useful drugs in several clinical cardiologic scenarios. Their use in the perioperative period and in critically ill patients is increasing, but their effect on clinically relevant outcomes remains controversial. Long-acting β-blockers can have detrimental effects that are difficult to be counteracted in these settings. The authors describe the possible clinical uses of ultra-short-acting β-blockers (esmolol and landiolol) in the perioperative period and in critically ill patients because these drugs have the beneficial effects of β-blockers, but do not have the detrimental effects of long-acting agents. This narrative review focuses on ultra-short-acting β-blockers in the following clinical settings: prevention and treatment of arrhythmias and myocardial ischemia in noncardiac and cardiac surgery, usage as cardioplegia adjuvants or to test the reversibility of systolic anterior motion of the mitral valve in cardiac surgery, medical treatment of aortic dissection before surgery, improvement of microcirculation and oxygenation in critically ill patients experiencing sepsis or undergoing extracorporeal membrane oxygenation, anesthesia induction, and coronary computed tomography angiography.
β受体阻滞剂在多种临床心脏病学场景中都是有用的药物。它们在围手术期和重症患者中的使用正在增加，但其对临床相关结局的影响仍存在争议。长效β受体阻滞剂可能产生有害影响，在这些情况下难以抵消。作者描述了超短效β受体阻滞剂（艾司洛尔和兰地洛尔）在围手术期和重症患者中的可能临床用途，因为这些药物具有β受体阻滞剂的有益作用，但没有长效制剂的有害作用。这篇叙述性综述聚焦于超短效β受体阻滞剂在以下临床场景中的应用：非心脏和心脏手术中预防和治疗心律失常及心肌缺血、在心脏手术中用作心脏停搏辅助药物或用于测试二尖瓣收缩期前向运动的可逆性、手术前主动脉夹层的药物治疗、改善脓毒症或接受体外膜肺氧合的重症患者的微循环和氧合、麻醉诱导以及冠状动脉计算机断层扫描血管造影。
