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

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.