Perioperative issues: myocardial ischemia and protection--beta-blockade.
Approximately one third of patients undergoing noncardiac surgery have coronary artery disease, and cardiovascular complications are an important cause of perioperative morbidity and mortality. Several algorithms are available to assess the risk for peri-operative cardiac events. Although preoperative risk assessment is useful in identifying patients at greatest risk for cardiac complications, recent investigations have provided additional guidance in choosing interventions to improve perioperative outcomes. These investigations show that perioperative beta-blockers significantly reduce morbidity and mortality in noncardiac surgery and appear to offer the greatest benefit to high-risk patients. Because of the lower complication rate in intermediate- and low-risk patients and the absence of large randomized controlled trials, the role of beta-blockers in this population is less well-defined.
Maggio
Paul M
PM
Department of Surgery, University of Michigan Health System, University Hospital, Room 1C421, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0033, USA. pmaggio@umich.edu
Taheri
Paul A
PA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D019990:Perioperative Care / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists