Perioperative beta-blocker therapy and heart rate control during noncardiac surgery.
BACKGROUND
Perioperative treatment with beta-blockade is a widely advocated practice. We assessed the preoperative, intraoperative, and postoperative control of heart rate (HR) in patients who received beta-blockade as recommended during preoperative medicine clearance.


METHODS
We conducted a retrospective review of patients who underwent noncardiac surgery from 2002 to 2004 at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, with recommendations of beta-blockade as part of their risk stratification. Demographic data and comorbid risk factors were collected on patients undergoing general anesthesia. All data were presented as mean +/- SEM. The chi-square test and analysis of variance were used for statistical analysis.


RESULTS
A total of 130 patients referred for preoperative medicine clearance, who were risk-stratified based on comorbid conditions and risk of procedure, had beta-blockade started before elective surgery. Sixty percent (78 of 130) of the patients underwent high-/intermediate-risk surgery. The mean preoperative HR was 74 +/- 1 beat per minute (bpm). The mean intraoperative HR was 69 +/- 1 bpm. The mean postoperative HR was 84 +/- 1 bpm. There was a significant difference in the preoperative and intraoperative HR when compared with the postoperative HR (P < .003). There were no deaths at 30 days postoperatively. Perioperative cardiac morbidity occurred in 5.4% (7 of 130) of all patients (high patient risk, 71%; low patient risk, 29%; P < .05), and did not correlate with procedure risk.


CONCLUSIONS
Beta-blockade is achieved sufficiently in the preoperative and intraoperative settings. However, attention to postoperative HR may be warranted to maintain the benefits of beta-blockade.
Berg
Carolyn
C
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Hospital, MED VAMC, OCL (112), 2002 Holcombe Blvd., Houston, TX 77030, USA.
Berger
David H
DH
Makia
Ayuk
A
Whalen
Caleb
C
Albo
Daniel
D
Bellows
Charles
C
Awad
Samir S
SS
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000768:Anesthesia, General; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists