Beta-adrenergic blockers and vasovagal episodes during shoulder surgery in the sitting position under interscalene block.

Abstract:

UNLABELLED:Shoulder surgery is often performed with patients in the sitting position under interscalene block anesthesia. Vasovagal episodes, characterized by a sudden decrease in heart rate and/or blood pressure, have a reported incidence of 17%-24% in this setting. We performed a retrospective study to determine whether there was an association between the use of beta-adrenergic blockers and the incidence of these episodes. Of the 150 patients identified, 20 (13.3%) had a vasovagal event. Similar proportions of patients had received a beta-adrenergic blocker in the group who had a vasovagal event compared with those who did not (20% vs 18%; P = 0.95). No other differences could be identified. We conclude that vasovagal episodes occur frequently in this setting with no identifiable risk factors. Beta-adrenergic blockers were not associated retrospectively with either an increased or decreased incidence of these episodes. The most likely mechanism involves the Bezold-Jarisch reflex. IMPLICATIONS:In this retrospective study of 150 patients who underwent shoulder surgery in the sitting position under interscalene block, we found a 13% incidence of vasovagal episodes. Unlike a previous study, this was not affected by the use of beta-blockers. A randomized, prospective study is necessary to clarify this issue.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Kahn RL,Hargett MJ

subject

Has Abstract

pub_date

1999-02-01 00:00:00

pages

378-81

issue

2

eissn

0003-2999

issn

1526-7598

journal_volume

88

pub_type

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