beta-Adrenergic Blockers and Vasovagal Episodes During Shoulder Surgery in the Sitting Position Under Interscalene Block

• Published in: Anesthesia and analgesia Vol. 88; no. 2; pp. 378 - 381
• Main Authors: Kahn, Richard L, Hargett, Mary J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.02.1999; Lippincott
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure - physiology; Bradycardia - etiology; Chemoreceptor Cells - physiology; Female; Heart Rate - physiology; Humans; Hypotension - etiology; Incidence; Male; Medical sciences; Middle Aged; Neck Muscles - innervation; Nerve Block; Neural Pathways - physiology; Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics; Posture; Reflex - physiology; Retrospective Studies; Risk Factors; Shoulder - surgery; Syncope, Vasovagal - etiology; Arrhythmia; Brachial plexus; Diseases of the osteoarticular system; Cardiovascular disease; Vasovagal syncope; β-Adrenergic receptor; Regional anesthesia; Heart disease; Shoulder; Seated position; Complication; Antagonist; Neurological disorder; Human; Nervous system diseases; Consciousness impairment; Excitability disorder; Bradycardia; Chemotherapy; Orthopedic surgery; Treatment; Arterial hypotension; Diseases of the autonomic nervous system; Surgical approach; Patient position; Beta blocking agent
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199902000-00029

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. ImplicationsIn 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.(Anesth Analg 1999;88:378-81)