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January 7, 1983

Propranolol Infusion After Abdominal Surgery

Author Affiliations

Emory University School of Medicine Atlanta

JAMA. 1983;249(1):22. doi:10.1001/jama.1983.03330250018018

To the Editor.—  We refer to the article entitled "Continuous Propranolol Infusion Following Abdominal Surgery" by Smulyan et al (1982; 247:2539). For the past three years, we have been infusing propranolol hydrochloride in patients unable to take oral drugs after coronary artery bypass surgery.1,2 We have the following comments and suggestions regarding this mode of propranolol administration.Infusion rates of 2 to 3 mg/hr usually produce levels within the therapeutic range within the first three hours, but if the levels are too low or reached too slowly, it is better to give one or more intravenous (IV) bolus doses (1 mg each) than to increase the infusion rate, a practice well illustrated in the clinical use of lidocaine hydrochloride infusions (JAMA 1976;236:273). Given an average elimination halftime of approximately four hours in normal subjects,3 steady-state levels of propranolol will not be achieved until the infusion has continued at