Possible indications of beta-blockers in the perioperative period other than prevention of cardiac ischemia

J Anesth. 2010 Feb;24(1):81-95. doi: 10.1007/s00540-009-0865-x.


According to the guidelines of the American College of Cardiology/American Heart Association 2006 for perioperative cardiovascular evaluation for non-cardiac surgery, beta-blocker therapy should be considered for high-risk individuals undergoing vascular surgery or high- and intermediate-risk patients undergoing non-cardiac surgery. This guideline might induce physicians to increasingly use beta-blockers in the hope of preventing perioperative cardiac complications. However, beta-blockers have potential beneficial effects outside the prevention of cardiac events. In addition to reducing anesthetic and analgesic requirements during the perioperative period, beta-blockers have neuroprotective effects in patients with brain trauma and possible effectiveness in the management of intraoperative awareness-induced post-traumatic stress disorder. Moreover, intrathecal administration of beta-blockers may have antinociceptive effects. Physicians need to bear in mind the benefits of beta-blockers for purposes other than preventing cardiac events when applied in the perioperative period, and they should be familiar with the pharmacodynamics and risk-benefit ratio with their use. This review focuses on possible extracardiac indications of beta-blockers.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Analgesics / therapeutic use*
  • Anesthetics / therapeutic use
  • Animals
  • Central Nervous System / drug effects
  • Drug Interactions
  • Humans
  • Immunomodulation / drug effects
  • Neuroprotective Agents / therapeutic use*
  • Perioperative Care / methods*


  • Adrenergic beta-Antagonists
  • Analgesics
  • Anesthetics
  • Neuroprotective Agents