Efficacy and Safety of Beta-Adrenoblocker Treatment During Postoperational Period After Extracardial Surgery - A Paradigm Shift?

For a long time beta-blockers (BB) have been sure the leading drug class to prescribe with preventive aims for myocardial infarction MI or cardiovascular morbidity in intra- and early postoperational periods of extracardial surgical interventions. However during last years the results of the most salient trials of the DECREASE family, showing positive effects of BB on decrease of intraoperational MI, were discredited. The review concerns on contemporary thought on pathogenesis of perioperational MI; the studies are analyzed which have explored various aspects of BB use in perioperational period. It is shown that their short-term action is mostly supress of stress reactions of cardiovascular system, and long-term effects are decrease of inflammatory mediators levels; this leads to atherosclerotic plaques stabilization and their volume decrease. Also we do not have good enough data on benefits or lack of perioperationsl therapy by BB, and the problem of the safety and efficacy of BB use is still open. To answer this more trials needed with perfectly formulated targets and thoroughly worked out design, choice of drug, compliant dosing regimen, dose titration, strict control of target heartrate and plodd pressure, and strict endpoints.