beta-Blockers and reduction of cardiac events in noncardiac surgery: clinical applications.
Recent studies suggest that beta-blockers administered perioperatively may reduce the risk of adverse cardiac events and mortality in patients who have cardiac risk factors and undergo major noncardiac surgery. The objective of this article is to provide practicing physicians with examples of perioperative beta-blocker use in practice by using several hypothetical cases. Although current evidence describing the effectiveness of perioperative beta-blockade may not address all possible clinical situations, it is possible to formulate an evidence-based approach that will maximize benefit to patients. We describe how information from several sources can be used to guide management of patients with limited exercise tolerance, those at highest risk for perioperative cardiac events, patients who are taking beta-blockers long-term, and those with relative contraindications to beta-blockade. Even though fine points of their use remain to be elucidated, perioperative beta-blocker use is important and can be easily applied in practice by any physician involved with the care of patients perioperatively.
Auerbach
Andrew D
AD
Department of Medicine, Box 0120, University of California, San Francisco, San Francisco, CA 94143-0120, USA. ada@medicine.ucsf.edu
Goldman
Lee
L
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003082:Colectomy; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D013565:Sympatholytics / Q000627:therapeutic use*; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D013565:Sympatholytics