Table 1.
Characteristics of the studies included in the Meta-analysis.
| Raby | Urban | Balser | ||||
|---|---|---|---|---|---|---|
| Journal | Anesth Analg | Anesth Analg | Anesthesiology | |||
| Year of publication | 1999 | 2000 | 1998 | |||
| Study design | Double-blind | Open | Open | |||
| No. of patients (esmolol) | 15 | 52 | 34 | |||
| No. of patients (control) | 11 | 55 | 30b | |||
| No. of groups | 2 | 2 | 2 | |||
| Preoperative beta-blocker administration,% of randomised patients (esmolol/control) | 33/36 | 27/29 | 39/30 | |||
| Intervention | Esmolol 100–300 µg/kg/min | Esmolol 250 mg/h | Esmolol with a bolus of 12.5–250 mg followed by an infusion of 50–150 µg/kg/min | |||
| Length of administration | 48 hours | 18–24 hoursa | 12 hours | |||
| Starting time of intervention | After surgery | After surgery | After surgery | |||
| Control | Placebo | Placebo | Diltiazem with a bolus of 20–45 mg followed by an infusion of 10–15 mg/h | |||
| Haemodynamic target | Postoperative HR 20% below the ischaemic threshold (minimum of 60 bpm) | Postoperative HR below 80 bpm | Postoperative HR between 80–100 bpm | |||
| No. of patients treated with any beta-blockers in the control group | 9 (81.8) | 18 (32.7) | 0 | |||
| Type of surgery | Peripheral vascular | Orthopaedic | Non-cardiacc | |||
| Urgency |
NR |
|
Elective |
NR |
||
| Outcomes n (%) |
Esmolol |
Control |
Esmolol |
Control |
Esmolol |
Control |
| MI | 0 | 1 (9.1) | 1 (1.9) | 3 (5.5) | NR | NR |
| Myocardial ischaemia | 5 (33.3) | 8 (72.7) | 3 (5.8) | 8 (14.5) | NR | NR |
| Cardiac arrest | NR | NR | NR | NR | NR | NR |
| Cardiac death | 0 | 0 | NR | NR | NR | NR |
| Heart failure | 0 | 0 | NR | NR | NR | NR |
| UAP | 1 (6.6) | 0 | NR | NR | NR | NR |
| New-onset arrhythmias | NR | NR | NR | NR | NR | NR |
| Composite of cardiac events (1) | 1 (6.7) | 1 | 7 (13.5) | 12 (21.8) | NR | NR |
| AKI | NR | NR | NR | NR | NR | NR |
| Composite of renal events (2) | NR | NR | NR | NR | NR | NR |
| Bradycardia | NR | NR | 3 (5.8) | 0 | 0 | 0 |
| Hypotension | NR | NR | 1 (1.9) | 0 | 2 (5.9) | 1 (3.3) |
| Stroke | NR | NR | NR | NR | NR | NR |
| Bronchospasm | NR | NR | NR | NR | NR | NR |
| Comatose symptoms | NR | NR | NR | NR | NR | NR |
| Serious infection/sepsis | NR | NR | NR | NR | NR | NR |
| All-cause mortality | NR | NR | NR | NR | 10.5 (30.8) | 11 (37.9) |
(1) MI, unstable angina, heart failure, new-onset arrhythmias, cardiac death; (2) AKI, need for RRT, worsening development of chronic kidney failure.
HR: heart rate; bpm: beats per minute; NR: not reported; MI: myocardial infarction; UAP: unstable angina pectoris; AKI: acute kidney injury.
a
On the first postoperative morning esmolol was switched to oral metoprolol (starting dose 25 mg twice a day) that was titrated to keep HR below 80 bpm and continued for the next 48 hours.
bOne patient included at two separate times.
cSurgeries including major abdominal, urologic, thoracic, vascular, neurosurgery, and general surgery operations.