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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-14020

Zaugg, M; Bestmann, L; Wacker, J; Lucchinetti, E; Boltres, A; Schulz, C; Hersberger, M; Kälin, G; Furrer, L; Hofer, C; Blumenthal, S; Müller, A; Zollinger, A; Spahn, D R; Borgeat, A (2007). Adrenergic receptor genotype but not perioperative bisoprolol therapy may determine cardiovascular outcome in at-risk patients undergoing surgery with spinal block: the Swiss Beta Blocker in Spinal Anesthesia (BBSA) study: a double-blinded, placebo-controlled, multicenter trial with 1-year follow-up. Anesthesiology, 107(1):33-44.

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Abstract

BACKGROUND: Neuraxial blockade is used as primary anesthetic technique in one third of surgical procedures. The authors tested whether bisoprolol would protect patients at risk for cardiovascular complications undergoing surgery with spinal block. METHODS: The authors performed a double-blinded, placebo-controlled, multicenter trial to compare the effect of bisoprolol with that of placebo on 1-yr composite outcome including cardiovascular mortality, nonfatal myocardial infarction, unstable angina, congestive heart failure, and cerebrovascular insult. Bisoprolol was given orally before and after surgery for a maximum of 10 days. Adrenergic receptor polymorphisms and safety outcome measures of bisoprolol therapy were also determined. RESULTS: A total of 224 patients were enrolled. Spinal block could not be established in 5 patients. One hundred ten patients were assigned to the bisoprolol group, and 109 patients were assigned to the placebo group. The mean duration of treatment was 4.9 days in the bisoprolol group and 5.1 days in the placebo group. Bisoprolol therapy reduced mean heart rate by 10 beats/min. The primary outcome was identical between treatment groups and occurred in 25 patients (22.7%) in the bisoprolol group and 24 patients (22.0%) in the placebo group during the 1-yr follow-up (hazard ratio, 0.97; 95% confidence interval, 0.55-1.69; P = 0.90). However, carriers of at least one Gly allele of the beta1-adrenergic receptor polymorphism Arg389Gly showed a higher number of adverse events than Arg homozygous (32.4% vs. 18.7%; hazard ratio, 1.87; 95% confidence interval, 1.04-3.35; P = 0.04). CONCLUSIONS: Perioperative bisoprolol therapy did not affect cardiovascular outcome in these elderly at-risk patients undergoing surgery with spinal block.

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Clinical Chemistry
04 Faculty of Medicine > Center for Integrative Human Physiology
DDC:570 Life sciences; biology
610 Medicine & health
540 Chemistry
Language:English
Date:July 2007
Deposited On:20 Mar 2009 14:57
Last Modified:27 Nov 2013 23:40
Publisher:Lippincott Wiliams & Wilkins
ISSN:0003-3022
Additional Information:Comment in: Anesthesiology. 2008 Feb;108(2):338; author reply 338-9.
Publisher DOI:10.1097/01.anes.0000267530.62344.a4
PubMed ID:17585213
Citations:Web of Science®. Times Cited: 54
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