The experts debate: perioperative beta-blockade for noncardiac surgery--proven safe or not?
Guidelines on perioperative management of patients undergoing noncardiac surgery recommend the use of prophylactic perioperative beta-blockers in high-risk patients who are not already taking them, and their continuance in patients on chronic beta-blockade prior to surgery. These recommendations were challenged recently by results of the Perioperative Ischemic Evaluation (POISE), a large randomized trial of extended-release metoprolol succinate started immediately before noncardiac surgery in patients at high risk for atherosclerotic disease. While metoprolol significantly reduced myocardial infarctions relative to placebo in POISE, it also was associated with significant excesses of both stroke and mortality. The merits and limitations of POISE and its applicability in light of other trials of perioperative beta-blockade are debated here by two experts in the field-Dr. Don Poldermans and Dr. P. J. Devereaux (co-principal investigator of POISE).
Poldermans
Don
D
Department of Anesthesiology, Erasmus MC's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. d.poldermans@erasmusmc.nl
Devereaux
P J
PJ
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000188:drug therapy / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000379:methods*; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D008790:Metoprolol