Final answer:
The risk of perioperative stroke related to the use of metoprolol versus esmolol is not clearly established and could be attributable to many factors. However, the difference in the duration of action between the two drugs could theoretically affect perioperative stroke risk, although metoprolol's direct causation of stroke is not definitively proven.
Step-by-step explanation:
The question regarding why metoprolol is associated with perioperative stroke while esmolol is not seems to be focused on understanding the pharmacokinetic and pharmacodynamic differences between these two beta-blockers and how these differences may contribute to the risk of stroke. When comparing metoprolol and esmolol, especially in the context of perioperative care, the differential risk of stroke is not well established in the literature, and suggesting one has higher risk than the other could be misleading. However, discussing differences between the two drugs, the most relevant factor in this context could be the duration of action rather than the receptor specificity, lipid solubility, or renal excretion.
This is because the longer duration of metoprolol might lead to sustained low blood pressures which could, in theory, reduce cerebral perfusion if not properly managed. However, it's important to note that perioperative stroke can be multifactorial, and a direct causation by metoprolol is not conclusively proven.