Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany.
IS Global Campus Cliníc Rosselló, Barcelona Institute for Global Health, 132, 7è, Barcelona, 08036, Spain.
BMC Anesthesiol. 2024 Feb 27;24(1):80. doi: 10.1186/s12871-024-02456-2.
Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.
A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.
A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.
Chronic BB therapy was not associated with a reduced perioperative opioid consumption.
This study was registered at ClinicalTrials.gov ( NCT02265263 ) on the 15.10.2014 with the principal investigator being Univ.-Prof. Dr. med. Claudia Spies.
β受体阻滞剂（BB）治疗在心血管疾病的治疗中起着核心作用。越来越多的心血管疾病患者接受非心脏手术，其中阿片类药物是麻醉管理的一个组成部分。有证据表明，由于 G 蛋白偶联的β肾上腺素能和阿片受体之间的假定串扰，短期静脉内 BB 治疗可能会影响围手术期阿片类药物的需求。慢性 BB 治疗是否也会影响围手术期阿片类药物的需求尚不清楚。
对一项多中心观察性（BioCog）研究中前瞻性收集的数据进行了事后分析。纳入标准包括接受择期非心脏手术的老年患者（≥65 岁）以及不使用区域麻醉且麻醉时间≥60 分钟的全静脉内全身麻醉。定义了两组：常规术前用药中使用 BB 和不使用 BB 的患者。所给予的阿片类药物转换为各自的吗啡等效剂量。使用吗啡指数进行多元回归分析，以确定独立的预测因子。
共有 747 名患者在柏林的研究中心参加了 BioCog 研究。106 名患者符合纳入标准。其中 37 名患者服用慢性 BB。与未服用 BB 的患者相比，后者术前更有可能患有动脉高血压（94.6%）、慢性肾功能衰竭（27%）和高脂蛋白血症（51.4%）。两组在累积围手术期吗啡等效剂量方面无差异（BB 组 230.9mg 与非 BB 组 214.8mg）。增加吗啡指数的预测因素为年龄较大、男性、麻醉和手术时间较长。在对数化吗啡指数的模型中，只有性别（女性）和麻醉时间仍然是预测因素。
慢性 BB 治疗与围手术期阿片类药物消耗减少无关。
这项研究于 2014 年 10 月 15 日在 ClinicalTrials.gov（NCT02265263）注册，首席研究员是 Claudia Spies 教授。
