Beta-adrenergic blocking agents and anaesthesia: a review.

RECENT DEVELOPMENTS in physiological and pharmacological studies involving the autonomic nervous system have uncovered intriguing new dimensions. It appears that clinical medicine will be influenced significantly by these discoveries. Diverse pathological entities such as angina pectoris, 1-9 cardiac arrhythrnias 1,",x~ obstructive cardiomyopathies, 1~,19,2~ phaeochromocytoma, 3,21-=" and essential hypertension 24,25 are some likely areas where therapeutic benefits may be realized. Anaesthesia and the autonomic nervous system are interrelated to a profound degree. Brewster's demonstration 2~ of the deleterious effects of ether in the absence of sympathetic integrity is an illuminating example. Correlation of depth of cyclopropane and ether anaesthesia with plasma catecholamine levels by Price "~ was another milestone in understanding anaesthetic impact on the sympathetic nervous system. These two examples point out the need for the anaesthesiologist's appreciation and knowledge concerning interrelationships between anaesthesia and the autonomic nervous system. The obiective of this review is to examine what we presently know about beta-adrenergic blockade, and its influence upon anaesthesiology. Readers wishing to pursue other facets of beta-adrenergic blockade should consult a recent review by Epstein and Braunwald. =~