Massive Propranolol Therapy and Uncomplicated Cardiac Surgery

Abstract

CLINICAL practice in several major centers and our recent hemodynamic work 1 support the thesis that therapy with propranolol hydrochloride in moderate doses need not necessarily be discontinued before open heart surgery. However, it is possible that patients who are receiving large doses of propranolol might have adverse responses to anesthesia and operation, particularly if they have suffered recent loss of myocardium. Uncomplicated anesthesia and open heart surgery was performed in a patient who had two recent myocardial infarctions and was taking the equivalent of 2,800 mg of propranolol hydrochloride/70kg/24 hr and who had high preoperative serum propranolol levels. Report of a Case A 55-year-old dwarf weighing 40 kg was scheduled for cardiac surgery. Seven months previously he had suffered an anterior myocardial infarction, followed by a repeated infarction six weeks before surgery. Four weeks before surgery, he was admitted to the hospital because of severe, persistent chest pain that