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BJA Advance Access originally published online on May 14, 2004
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British Journal of Anaesthesia, 2004, Vol. 93, No. 1 53-62
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Sympatho-modulatory therapies in perioperative medicine

M. Zaugg*,1,2, C. Schulz1, J. Wacker1 and M. C. Schaub2

1 Institute of Anaesthesiology, University Hospital Zurich, Switzerland. 2 Institute of Pharmacology and Toxicology, University of Zurich, Switzerland

*Corresponding author. E-mail: michael.zaugg@usz.ch

Keywords: agonists, alpha2-agonists; antagonists, beta-adrenergic antagonists; anaesthetic techniques, regional; heart, perioperative cardioprotection; receptors, adrenergic; sympathetic nervous system

The first 150 words of the full text of this article appear below.


   Introduction
 
With increasing life expectancy and improved surgical technology an ever-larger number of elderly patients with cardiovascular disease, or significant cardiovascular risk factors will undergo major surgery. More than 5% of an unselected surgical population undergoing non-cardiac surgery will suffer from perioperative cardiovascular complications including myocardial infarction and cardiac death. The incidence of adverse cardiac events may even reach 30% in high-risk patients undergoing vascular surgery causing a substantial financial burden of perioperative health care costs.59 Thus, all therapeutic measures should be undertaken to reach the challenging goal of a lower incidence of perioperative cardiovascular complications.

Gaining control over sympathetic nervous system activity, that is blunting the adrenergic response to the surgical trauma, traditionally represents an important aspect of anaesthetic practice.21 Anaesthesiology has been regarded as the ‘practice of autonomic nervous system medicine’. While variable and moderate changes in sympathetic nervous system activity function as a servo-control mechanism and are even . . . [Full Text of this Article]


   Adrenergic activity in the heart: a double-edged sword
 
Changing therapeutic paradigms: a historical perspective
Implications for perioperative medicine

   Sympatho-modulation by medication
 
Alpha2-agonists and the cardiovascular system
ß-AAs and the cardiovascular system

   Sympatho-modulation by regional anaesthesia/analgesia
 
General comments
Spinal anaesthesia
Epidural anaesthesia/analgesia

   Sympatho-modulatory therapies: does it make sense to combine them?
 

   Conclusions
 

   Acknowledgements
 

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