title: Cardioprotective effects of perioperative β-blockade in vascular surgery patients: fact or fiction?
abstract: OBJECTIVE
  Perioperative β-blockade remains a subject of debate. In this review, recent literature and current guidelines for perioperative β-blockade in vascular surgery patients are discussed.
  
  
  RESULTS
  Available evidence suggests that perioperative β-blockade may be beneficial in reducing cardiac events. However, in a recent large study, the incidences of stroke and mortality were increased in patients on perioperative β-blockers. Large systematic reviews failed to demonstrate a net beneficial effect of perioperative β-blockers. The 2009 American and the European guidelines for perioperative β-blockade in vascular surgery disagree on the available evidence but do recommend β-blockade for several indications. Most recent, Wallace and colleagues published a large-sized retrospective study, reporting a beneficial effect of the adoption of a protocol for perioperative β-blockade.
  
  
  CONCLUSIONS
  Perioperative β-blockade reduces cardiac events, but at the expense of increased risk for mortality and stroke. The guidelines seem to be eager to follow positive outcome studies, without considering the effects of β-blockade on other organ systems. Perhaps the main reason for the reported cardioprotective effects of perioperative β-blocker therapy should be sought in failing preoperative β-blocker prophylaxis (irrespective of surgery).
authors.affiliation: Division of Perioperative Care and Emergency Medicine, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Flier
authors.forename: Wolfgang F
authors.initials: WF
authors.lastname: Buhre
authors.forename: Wilton A
authors.initials: WA
authors.lastname: van Klei
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D006801:Humans; D015201:Meta-Analysis as Topic; D008790:Metoprolol / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000503:physiopathology; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol