The Effect of Perioperative β-blockade on the Pulmonary Function of Patients Undergoing Major Arterial Surgery

IntroductionConcern about the potential detrimental side-effects of β-blockade on pulmonary function often dissuades against their perioperative use in patients undergoing major arterial surgery (especially in those with chronic obstructive pulmonary disease (COPD)). In this study we aimed to establish prospectively the clinical relevance of these concerns.MethodsAfter ethics committee approval and individual informed consent, the pulmonary function of twenty patients (mean age 68.7 years (range 43–82), 11 males) scheduled to undergo non-emergency major vascular surgery was studied by recording symptoms and spirometry before and after institution of effective β-blockade. Fifteen patients (75%) had significant smoking histories (mean pack years/patient=50), while 12 (60%) had COPD.ResultsAll patients tolerated effective β-blockade satisfactorily without developing either subjective deterioration in symptoms or significant change on spirometry. The mean change in FEV1 following adequate β-blockade was 0.05±0.24 liters (95% CI −0.06 to +1.61), p=0.35, giving a mean percentage change of 3.18%±11.66 (95% CI −2.26 to 8.62).ConclusionsPreviously held concerns about worsening pulmonary function through the short-term use of β-blockers should not dissuade their perioperative usage in patients with peripheral vascular disease. Furthermore, the accuracy of pulmonary function tests in preoperative assessment and risk stratification also appears unaffected by this therapy