Clin Colon Rectal Surg 2013; 26(03): 160-162
DOI: 10.1055/s-0033-1351131
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perioperative Beta Blockade

Jennifer Lynn Irani
1   Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
19 August 2013 (online)

Abstract

The use of preoperative beta (β) blockade has been through several changes, and it is clear that large, randomized controlled trials on the subject are in need. Currently, a judicious approach to perioperative β blockade is supported. Continuation of β blockers is recommended for the patient taking them prior to surgery. Patients undergoing large colorectal procedures, with coronary artery disease or high cardiac risk, should have β blockers titrated to heart rate and blood pressure. Dosages should be titrated to heart rate and blood pressure rather than using fixed, long-acting dosages. When β blockers are indicated, they should be initiated weeks before surgery.

 
  • References

  • 1 Devereaux PJ, Yang H, Yusuf S , et al; POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008; 371 (9627) 1839-1847
  • 2 Boersma E, Kertai MD, Schouten O , et al. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med 2005; 118 (10) 1134-1141
  • 3 Mangano DT, Layug EL, Wallace A, Tateo I. Multicenter Study of Perioperative Ischemia Research Group. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med 1996; 335 (23) 1713-1720
  • 4 Fleisher LA, Beckman JA, Brown KA , et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2009; 120 (21) e169-e276
  • 5 Lee TH, Marcantonio ER, Mangione CM , et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100 (10) 1043-1049
  • 6 Fleisher LA, Beckman JA, Brown KA , et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Rhythm Society; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine; Society for Vascular Surgery. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol 2009; 54 (22) e13-e118
  • 7 Dunkelgrun M, Boersma E, Schouten O , et al; Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg 2009; 249 (6) 921-926
  • 8 van der Maas PJ, Löwenberg B, Peters RJG , et al. Report Summary [Internet]. Erasmus MC, University Medical Center Rotterdam: Committee for the Investigation of Scientific Integrity; 2011. Available at: http://www.erasmusmc.nl/5663/135857/3397899/report_summary_investigation_integrity?lang=en . Accessed January 17, 2012
  • 9 Chopra V, Plaisance B, Cavusoglu E, Flanders SA, Eagle KA. Perioperative beta-blockers for major noncardiac surgery: primum non nocere. Am J Med 2009; 122 (3) 222-229
  • 10 Auerbach AD, Goldman L. Beta-blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA 2002; 287 (11) 1435-1444
  • 11 Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 2005; 353 (4) 349-361
  • 12 Potenza B, Deligencia M, Estigoy B , et al. Lessons learned from the institution of the Surgical Care Improvement Project at a teaching medical center. Am J Surg 2009; 198 (6) 881-888
  • 13 Fleischmann KE, Beckman JA, Buller CE , et al. 2009 ACCF/AHA focused update on perioperative beta blockade: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2009; 120 (21) 2123-2151