• David W Amory, Alina Grigore, John K Amory, Mark A Gerhardt, William D White, Peter K Smith, Debra A Schwinn, J G Reves, and Mark F Newman.
• Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Heart Center, Durham, NC 27710, USA.
• J. Cardiothorac. Vasc. Anesth. 2002 Jun 1; 16 (3): 270-7.

ObjectiveTo determine the impact of perioperative beta-adrenergic receptor (betaAR) antagonist administration on neurologic complications.DesignObservational database analysis.SettingA clinical investigation at a single tertiary academic medical center.ParticipantsElective coronary artery bypass graft surgical patients operated on in the period 1994-1996.InterventionsPatients were divided into 2 groups: (1) patients given betaAR antagonist-blocking drugs in the perioperative period, including during operation, and (2) patients not given betaAR antagonists.Measurements And Main ResultsbetaAR 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 betaAR antagonist therapy, and 279 (11%) did not. Adverse neurologic events occurred in 3.9% (n = 90) of patients who received perioperative betaAR antagonists and 8.2% (n = 23) of patients who did not receive betaAR 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 betaAR antagonists and 4.3% (n = 12) of patients who did not receive betaAR antagonists (odds ratio, 0.43; 95% confidence interval, 0.23 to 0.83; p = 0.016).ConclusionUse of beta-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.Copyright 2002, Elsevier Science (USA). All rights reserved.

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