April 23, 2011

Beta blocker in patient undergoing surgery

This is some argument in respond to my past year Professional III examination regarding preoperative preparation of patients. The statement is like this

"Beta blocker medication should be stopped in the day of surgery"

The answer is false because.

1) Class I indication for perioperative beta-blocker use exists for continuation of a beta blocker in patients already taking the drug

2) several Class IIa recommendations exist for patients with inducible ischemia, coronary artery disease, or multiple clinical risk factors who are undergoing vascular (i.e., high-risk) surgery and for patients with coronary artery disease or multiple clinical risk factors who are undergoing intermediate-risk surgery

3) Initiation of therapy, particularly in lower-risk groups, requires careful consideration of the risk:benefit ratio for an individual patient

4) Initiation well before a planned procedure with careful titration perioperatively to achieve adequate heart rate control while avoiding frank bradycardia or hypotension is also suggested.

5) In light of the POISE results, routine administration of perioperative beta blockers, particularly in higher fixed-dose regimens begun on the day of surgery, cannot be advocated

** Notes: POISE trial showed that, though preoperative beta blockers prevented 15 MI’s for every 1000 patients treated, there was an increased risk of stroke and an excess of 8 deaths per 1000 patients treated


Joshua A. Beckman, Christopher E. Buller, Hugh Calkins et al, "2009 ACCF/AHA Focused Update on Perioperative Beta Blockade", Journal of the American College of Cardiology, 2009

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