Esmolol reduces perioperative ischemia in noncardiac surgery: a meta-analysis of randomized controlled studies

Objective: Literature increasingly has suggested how beta-blockers could be associated with reductions of mortality and morbidity in noncardiac surgery. Recently, the POISE trial showed that beta-blockers could be harmful in the perioperative period. The authors performed a meta-analysis to evaluate the clinical effects of esmolol in noncardiac surgery. Design: Meta-analysis. Setting: Hospitals. Participants: A total of 1765 patients from 32 randomized trials. Interventions: None. Measurements and Main Results: Three investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of esmolol versus placebo, other drugs, or standard of care in noncardiac surgery. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no data on clinical outcomes. The use of esmolol was associated with a significant reduction of myocardial ischemia episodes (5/283 [1.76%] in the esmolol group v 16/265 [6.03%] in the control arm, odds ratio [OR] = 0.16 [0.05-0.54], p = 0.003). The authors did not observe significant differences regarding episodes of arrhythmias (8/236 [3.38%] v 22/309 [7.11%], OR = 0.52 [0.23-1.18], p = 0.12) and in the incidence of myocardial infarction (0/148 [0%] v 1/169 [0.59%], OR = 0.23 [0.01-6.09], p = 0.38). Esmolol-treated patients did not experience more episodes of hypotension (17/384 [4.42%] v 38/439 [8.65%], OR = 0.41 [0.22-0.79], p = 0.17) and bradycardia (25/342 [7.30%] v 17/406 [4.18%], OR = 1.42 [0.74-2.74], p = 0.42). Conclusions: Esmolol seemed to reduce the incidence of myocardial ischemia in noncardiac surgery without increasing the episodes of hypotension and bradycardia. Large randomized trials are necessary to confirm these promising results. (C) 2010 Elsevier Inc. All rights reserved.