Should my outpatient center have a beta-blocker protocol?
OBJECTIVE
Perioperative beta-blockade has been advocated by multiple authors and recent guidelines as a strategy to reduce cardiac risk in noncardiac surgery. Knowledge about application of this treatment modality to the ambulatory surgery population is poor.


RESULTS
Although the initial trial in patients with a positive stress test undergoing major vascular surgery demonstrated significantly fewer perioperative cardiac events among those randomized to perioperative beta-blocker therapy, more recent studies in patients without documented coronary artery disease undergoing major noncardiac surgical procedures were unable to demonstrate efficacy. Guidelines from the American Heart Association/American College of Cardiology have been reported and advocated class I recommendations for perioperative beta-blockade only for patients previously taking beta-blockers and those patients with a positive stress test undergoing vascular surgery. There was insufficient evidence to make a recommendation in low-risk surgery.


CONCLUSIONS
Based upon the available evidence and guidelines, patients currently taking beta-blockers and undergoing ambulatory surgery should continue these agents and protocols employing this strategy should be beneficial. In patients who are not currently taking beta-blockers and in whom long-term therapy is not warranted, current evidence does not support instituting prophylactic therapy in the ambulatory surgery population.
Fleisher
Lee A
LA
University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. fleishel@uphs.upenn.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000554:Ambulatory Care Facilities; D000556:Ambulatory Surgical Procedures / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D017202:Myocardial Ischemia / Q000517:prevention & control; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D014656:Vascular Surgical Procedures / Q000592:standards*
D000319:Adrenergic beta-Antagonists