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Correspondence  |   May 2007
β-Blockade Abolishes Anesthetic Preconditioning: Impact on Clinical Applicability
Author Affiliations & Notes
  • Franz Kehl, M.D., Ph.D., D.E.A.A.
    *
  • *Bayerische Julius-Maximillans-Universität, Würzburg, Germany.
Article Information
Correspondence
Correspondence   |   May 2007
β-Blockade Abolishes Anesthetic Preconditioning: Impact on Clinical Applicability
Anesthesiology 5 2007, Vol.106, 1062. doi:10.1097/01.anes.0000265173.82995.e6
Anesthesiology 5 2007, Vol.106, 1062. doi:10.1097/01.anes.0000265173.82995.e6
In Reply:—
We thank Drs. Riess and Stowe for their interest in our study on β1-adrenergic signaling in anesthetic preconditioning1 and for their question of how we would interpret the relevance of the experimental findings to clinical practice. Although results from experimental investigations should be interpreted with caution as to their clinical relevance, we do believe that β-blockers indeed might hamper beneficial effects of anesthetic preconditioning. Experimental data from our laboratory in addition demonstrate that the clinically widely used β1-selective blocker metoprolol dose-dependently abrogates desflurane-induced preconditioning.2 A recent meta-analysis of clinical studies of cardioprotection by volatile anesthetics in coronary artery bypass graft surgery confirmed a sustained reduction of postoperative cardiac troponin I release in patients receiving volatile anesthetics.3 However, the results of this study do also suggest a possible interaction between β-blocker prophylaxis and anesthetic preconditioning. The use of β-blockers was disproportioned: Patients receiving volatile anesthetics had a 28% lower incidence of β-blocker use compared with patients receiving intravenous anesthetics. This leads us to the conjecture that no beneficial effects of volatile anesthetics would have been found had β-blocker use been equally distributed. Therefore, we share the concern of Drs. Riess and Stowe insofar as in clinical practice, apart from constraints such as age, hyperglycemia, and diabetes,4 cardiovascular comedication might attenuate beneficial effects of volatile anesthetics.
*Bayerische Julius-Maximillans-Universität, Würzburg, Germany.
References
Lange M, Smul TM, Blomeyer CA, Redel A, Klotz KN, Roewer N, Kehl F: Role of the β1-adrenergic pathway in anesthetic and ischemic preconditioning against myocardial infarction in the rabbit heart in vivo  . Anesthesiology 2006; 105:503–10Lange, M Smul, TM Blomeyer, CA Redel, A Klotz, KN Roewer, N Kehl, F
Lange M, Smul T, Redel A, Roewer N, Kehl F: Coadministration of desflurane and metoprolol blocks anesthetic-induced preconditioning and cardioprotective effects of beta adrenergic blockade in the rabbit heart in vivo  (abstract). Anesthesiology 2005; 103:A469Lange, M Smul, T Redel, A Roewer, N Kehl, F
Yu CH, Beattie WS: The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: A meta-analysis. Can J Anaesth 2006; 53:906–18Yu, CH Beattie, WS
Kehl F, Krolikowski JG, Mraovic B, Pagel PS, Warltier DC, Kersten JR: Hyperglycemia prevents isoflurane-induced preconditioning against myocardial infarction. Anesthesiology 2002; 96:183–8Kehl, F Krolikowski, JG Mraovic, B Pagel, PS Warltier, DC Kersten, JR