title: Successful implementation of perioperative beta-blockade utilizing a multidisciplinary approach.
abstract: OBJECTIVE
  To describe how we implemented a protocol for perioperative beta-blockade in patients with or at risk of coronary artery disease (CAD) undergoing major non-cardiac surgery and to present our results.
  
  
  METHODS
  After institutional approval, from May 1999 to April 2001, patients with surgical and medical indications (CAD as indicated by previous myocardial infarction, typical angina or atypical angina with a positive stress test or at least two risk factors for CAD: age 65 yr, hypertension, smoking, high cholesterol, diabetes mellitus) for perioperative beta-blockade were identified preoperatively by anesthesiology and referred to the General Internal Medicine Service (MED). MED initiated patients on outpatient beta-blockers. The intraoperative anesthetic management was left to the discretion of the anesthesiologist. In the postanesthesia care unit (PACU), patients received iv metoprolol according to hemodynamic criteria. Postoperatively, patients were followed by MED for adverse cardiac events.
  
  
  RESULTS
  Sixty-nine patients received perioperative beta-blockade. Preoperatively, 60% were started on metoprolol, 39% on atenolol and 1% on propranolol. In PACU, 42%, 9% and 38% of patients were given iv metoprolol 0, 5 and 10 mg respectively. One patient was given glycopyrrolate in the PACU for bradycardia and none received vasoactive or inotropic agents. Three patients (4.3%) had postoperative cardiac events.
  
  
  CONCLUSIONS
  With close collaboration between anesthesiologists, internists, PACU nurses and family physicians, a strategy for perioperative beta-blockade was implemented successfully in patients with cardiac risks. Beta-blockade was associated with few side effects and morbidities.
authors.affiliation: Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Armanious
authors.forename: David T
authors.initials: DT
authors.lastname: Wong
authors.forename: Edward
authors.initials: E
authors.lastname: Etchells
authors.forename: Patrick
authors.initials: P
authors.lastname: Higgins
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D003324:Coronary Artery Disease / Q000188:drug therapy*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D007432:Intraoperative Period; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D010351:Patient Discharge; D011300:Preoperative Care; D012306:Risk
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol