title: Perioperative β-Blockers in Patients Undergoing Noncardiac Surgery-Scientific Misconduct and Clinical Guidelines.
abstract: BACKGROUND
  β-blocker use in perioperative period of noncardiac surgeries has been a topic of debate since many years. Earlier studies conducted in the 90s showed decreased cardiac adverse events and improved postoperative outcomes with β-blocker use. Based on this, the ACCF and ESC published guidelines strongly supporting β-blocker use. But contemporaneous studies conducted revealed conflicting evidence and have also proven some of the earlier studies to be fraudulent. Although ACCF guidelines have been updated to partially reflect the changes, ESC guidelines continue to support β-blocker use.
  In light of the ACCF and ESC guidelines supporting β-blocker use in perioperative period of noncardiac surgeries, our aim was to review the available literature and consolidate evidence in this regard.
  
  
  METHODS
  PubMed search was conducted to include relevant studies between 1950 and 2015.
  
  
  RESULTS
  We reviewed 24 eligible studies and few debates conducted in this regard. Based on our review, our findings were as follows: β-blockers should be continued throughout perioperative period in patients who were on β-blockers before surgery for other indications such as angina, hypertension, and symptomatic arrhythmias. Preoperative β-blockers are indicated in patients undergoing high risk vascular surgery or those having high preoperative Cardiac Risk Index Score. In patients with intermediate-to-low cardiac risk, the proven benefit is not sufficient enough to suggest universal use.
  
  
  CONCLUSIONS
  Based on our review, we conclude that the use of β-blockers in perioperative period of noncardiac surgeries should be determined on an individual basis based on risk-benefit analysis. Guideline organizations should update their recommendations based on new evidence.
authors.affiliation: Department of Medicine, Chicago Medical School, North Chicago, IL.
authors.forename: Dhauna
authors.initials: D
authors.lastname: Karam
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D015871:Scientific Misconduct; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
chemical_list: D000319:Adrenergic beta-Antagonists