Interleukin balance and early recovery from anesthesia in elderly surgical patients exposed to β-adrenergic antagonism

Abstract

Study objective To determine whether proinflammatory and antiinflammatory cytokines, as measured in blood specimens, would correlate with improved SF-36 physical composite scores observed in elderly surgical patients who were administered perioperative atenolol. Design Post hoc analysis of data from a randomized clinical study. Setting Department of Anesthesiology, Mount Sinai Medical School, New York. Patients 59 ASA physical status II, III, and IV patients ≥65 years of age, who were scheduled for major elective noncardiac surgery. Interventions Patients were randomized to one of three anesthetic regimens to receive 1) perioperative management without β-adrenergic antagonism, 2) preoperative and postoperative administration of atenolol, or 3) intraoperative atenolol as a major component of the anesthetic regimen. Measurements and main results Blood samples were drawn perioperatively at seven different time points. Interleukin-1β, interleukin-6, interleukin-1ra, and interleukin-10 were measured using enzyme-linked immunosorbent assay (ELISA) kits. Also, recovery from anesthesia and physical/mental well-being (SF-36 questionnaire) were determined perioperatively. Compared with control patients, atenolol-treated patients experienced improved postoperative physical well-being, which paralleled the previously reported faster recovery from anesthesia and a decreased need for perioperative analgesics. Improved postoperative physical well-being of atenolol-treated patients was specifically caused by an ameliorated bodily pain score, a major component of the physical composite score of the SF-36 questionnaire. The cytokine response of these elderly surgical patients was similar to that of younger patients, and the perioperative profile of proinflammatory and antiinflammatory cytokines was not affected by atenolol. Conclusions Perioperative administration of atenolol to elderly surgical patients markedly improves physical sense of well-being, which coincides with improved postoperative pain control and decreased analgesic requirements. This improvement experienced by patients receiving atenolol is not related to alterations in perioperative cytokine response.