Perioperative use of beta-blockers remains low: experience of a single Canadian tertiary institution.
BACKGROUND
Perioperative beta-blockade appears to reduce morbidity and mortality in non-cardiac surgery, and is recommended by published guidelines. This study explores the frequency of perioperative beta-blockade and identifies factors limiting its use.


METHODS
We conducted a prospective analysis of consecutive patients seen by anesthesiologists before major non-cardiac surgery in a single month. Because not all patients undergoing major surgery were seen preoperatively by anesthesiologists, we also performed a retrospective analysis of patients who recently underwent such surgery. Data were collected on demographic information, cardiovascular risk factors, beta-blocker use, and perceived contraindications/barriers to beta-blocker use, using a validated instrument.


RESULTS
The prospective phase studied 222 patients preoperatively, of whom 96 were suitable candidates for perioperative beta-blockade by the American College of Physician guidelines. The retrospective phase studied 200 patients, of whom 63 were suitable candidates, and assessed pre- and postoperative use of beta-blockade. 40.6% and 38.1% of suitable patients received preoperative beta-blockade in the two phases, respectively. Findings were similar in those undergoing vascular surgery, suggesting that perception of perioperative risk did not influence the decision to use beta-blockade. Beta-blockers were not prescribed preoperatively because of lack of knowledge about contraindications to beta-blockade, and anesthesiologist reluctance to prescribe oral medication to outpatients.


CONCLUSIONS
Use of preoperative beta-blockade among suitable candidates appears to be approximately 40%. Anesthesiologists started preoperative beta-blockers infrequently even in patients without contraindications. These findings suggest that educating anesthesiologists about the perioperative use of beta-blockade may increase the use of this potentially beneficial strategy.
Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia.
Ivan
I
Rapchuk
Shannon
S
Rabuka
Marcello
M
Tonelli
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002170:Canada; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D011795:Surveys and Questionnaires
D000319:Adrenergic beta-Antagonists