Continuous propranolol infusion following abdominal surgery
H. Smulyan, S. E. Weinberg and P. J. Howanitz
Thirteen patients given long-term propranolol hydrochloride therapy for
heart disease required 15 abdominal surgical procedures. On each occasion,
propranolol therapy was maintained postoperatively by continuous
intravenous infusion. Duration of infusion ranged from one to nine days,
and each infusion was monitored with frequent measurements of serum
propranolol concentrations. In patients with normal hepatic and renal
function, therapeutic serum propranolol levels were attained with a narrow
dose range averaging 3.0 mg/hr, irrespective of body weight. All patients
had postoperative courses free of complications attributable to
beta-blockade. This form of therapy appears to protect against sympathetic
stimulation during the perioperative period and to prevent the propranolol
withdrawal syndrome in such patients. Continuous propranolol infusion might
also be useful in other clinical situations, such as acute aortic
dissection or severe thyrotoxicosis, where predictable therapeutic serum
propranolol levels could be maintained when oral therapy was
contraindicated.
