Volume 13 Supplement 1

Abstracts from the 26th National Congress of the Italian Society of Geriatric Surgery

Open Access

Prevention of perioperative atrial fibrillation with beta blockers in elderly patient during abdominal surgery

  • Gennaro Pagano1Email author,
  • Dario Leosco1,
  • Nicola Ferrara1, 2,
  • Nicola Rocco3,
  • Corrado Rispoli4,
  • Loredana Iannone5,
  • Serena Testa4,
  • Rita Compagna6,
  • Antonello Accurso6 and
  • Bruno Amato6
BMC Surgery201313(Suppl 1):A34

https://doi.org/10.1186/1471-2482-13-S1-A34

Published: 16 September 2013

Aim of the study

To investigate whether pharmacologic prophylaxis with Beta Blocker Carvedilol reduce perioperative Atrial Fibrillation (AF) in elderly patients during abdominal surgery.

Background

Peri-operative AF is the consequence of stress activation of Sympathetic Nervous System (SNS) following surgery [1, 2]. The incidence of AF increase with the aging and in presence of comorbidities [35]. Clinical consequences include reduced cardiac output, lengthened hospitalization, an increase in the risk of cerebral thromboembolism and in many cases the need for systemic anticoagulation [6]. SNS overactivation could be treated with Beta Blockers and may reduce the occurrence of AF [710].

Methods

A prospective, randomized, single-blind, controlled pilot study in patients undergoing abdominal surgery (right emicolectomy, sigmoidectomy and anterior rectal resection) was conducted. 22 elderly patients (70 years old and over) were randomized to control (ctr) (n = 13) and Carvedilol (carv) (n = 9) groups. Treatment was received only during and 36 hours after surgery in the carv group.

Results

The occurrence of AF were 3 in ctr group and in 0 in carv group (p < 0.0001). No statistical differences were present in demographic and clinical characteristics between two groups. No correlation was found between age and the incidence of AF..

Conclusions

In the elderly patients underwent abdominal surgery, the reduction of SNS with Beta Blocker Carvedilol should be useful to reduce the occurrence of peri-operative AF and, consequently, to reduce the impact of AF cardiovascular complications.

Authors’ Affiliations

(1)
Department of Translational Medical Sciences, Federico II University of Naples
(2)
“Salvatore Maugeri” Foundation, IRCCS Scientific Institute of Telese Terme
(3)
Department of Biomedical, Surgical and Dental Sciences, University of Milan
(4)
Department of General Surgery - ASL NA1, Cardinale Ascalesi Hospital
(5)
Department of General Surgery, Fatebenefratelli Hospital
(6)
Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, Federico II University of Naples

References

  1. Rengo G, Leosco D, Zincarelli C, Marchese M, Corbi G, Liccardo D, Filippelli A, Ferrara N, Lisanti MP, Koch WJ, Lymperopoulos A: Adrenal GRK2 lowering is an underlying mechanism for the beneficial sympathetic effects of exercise training in heart failure. American Journal of Physiology - Heart and Circulatory Physiology. 2010, 24 (9):Google Scholar
  2. Leosco D, Rengo G, Iaccarino G, Golino L, Marchese M, Fortunato F, Zincarelli C, Sanzari E, Ciccarelli M, Galasso G, Altobelli GG, Conti V, Matrone G, Cimini V, Ferrara N, Filippelli A, Koch WJ, Rengo F: Exercise promotes angiogenesis and improves β-adrenergic receptor signalling in the post-ischaemic failing rat heart. Cardiovascular Research. 2008, 30 (3):Google Scholar
  3. Rengo F, Parisi V, Rengo G, Femminella GD, Rengo C, Zincarelli C, Pagano G, Festa G, De Lucia C, Leosco D: Instruments for geriatric assessment: new multidimensional assessment approaches. JOURNAL OF NEPHROLOGY. 2012, 25: 73-78. 10.5301/jn.5000164. ISSN: 1121-8428, doi: 10.5301/jn.5000164View ArticleGoogle Scholar
  4. Pilotto A, Addante F, Franceschi M, Leandro G, Rengo G, D’Ambrosio P, Longo MG, Rengo F, Pellegrini F, Dallapiccola B, Ferrucci L: A Multidimensional Prognostic Index (MPI) based on a Comprehensive Geriatric Assessment Predicts Short-Term Mortality in Older Patients with Heart Failure. Circulation: Heart Failiure. 2010, 3: 14-20. 10.1161/CIRCHEARTFAILURE.109.865022.Google Scholar
  5. Rispoli C, Rocco N, Iannone L, Amato B: Developing guidelines in geriatric surgery: role of the grade system. BMC Geriatrics. 2009, 9 (SUPPL.1): A99-Google Scholar
  6. Rengo G, Pagano G, Squizzato A, Moja L, Femminella GD, de Lucia C, Komici K, Parisi V, Savarese G, Ferrara N, Perrone-Filardi P, Leosco D: Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis. PloS One. 2013, 8 (1): e52952-10.1371/journal.pone.0052952. doi:10.1371/journal.pone.0052952PubMed CentralView ArticlePubMedGoogle Scholar
  7. Paolillo S, Rengo G, Pagano G, Pellegrino T, Savarese G, Femminella GD, Tuccillo , Boemio A, Attena E, Formisano R, Petraglia L, Scopacasa F, Galasso G, Leosco D, Trimarco B, Cuocolo A, Perrone-Filardi P: Impact of Diabetes Mellitus on Cardiac Sympathetic Innervation in Patients With Heart Failure. A Iodine-123 meta-iodobenzylguanidine (I123MIBG) Scintigraphic Study. Diabetes Care. 2013Google Scholar
  8. Rengo G, Lymperopoulos A, Zincarelli C, Femminella Gd, Liccardo D, Pagano G, de Lucia C, Cannavo A, Gargiulo P, Ferrara N, Perrone Filardi P, Koch Wj, Leosco D: Blockade of beta-adrenoceptors restores the GRK2-mediated adrenal alpha(2) -adrenoceptor-catecholamine production axis in heart failure. BRITISH JOURNAL OF PHARMACOLOGY. 2012, 166: 2430-2440. 10.1111/j.1476-5381.2012.01972.x. ISSN: 1476-5381, doi: 10.1111/j.1476-5381.2012.01972.xPubMed CentralView ArticlePubMedGoogle Scholar
  9. Rengo G, Zincarelli C, Femminella GD, Liccardo D, Pagano G, de Lucia C, Altobelli GG, Cimini V, Ruggiero D, Perrone-Filardi P, Gao E, Ferrara N, Lymperopoulos A, Koch WJ, Leosco D: Myocardial beta(2) -adrenoceptor gene delivery promotes coordinated cardiac adaptive remodelling and angiogenesis in heart failure. BRITISH JOURNAL OF PHARMACOLOGY. 2012, 166: 2348-2361. 10.1111/j.1476-5381.2012.01954.x. ISSN: 1476-5381, doi: 10.1111/j.1476-5381.2012.01954.xPubMed CentralView ArticlePubMedGoogle Scholar
  10. Rengo G, Perrone-Filardi P, Femminella GD, Liccardo D, Zincarelli C, de Lucia C, Pagano G, Marsico F, Lymperopoulos A, Leosco D: Targeting the beta-adrenergic receptor system through G-protein-coupled receptor kinase 2: a new paradigm for therapy and prognostic evaluation in heart failure: from bench to bedside. CIRCULATION. HEART FAILURE. 2012, 5: 385-391. 10.1161/CIRCHEARTFAILURE.112.966895. ISSN: 1941-3289, doi: 10.1161/CIRCHEARTFAILURE.112.966895View ArticlePubMedGoogle Scholar

Copyright

© Pagano et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Advertisement