2009 ACCF/AHA Focused Update on Perioperative Beta Blockade

Fleischmann, Kirsten E.; Beckman, Joshua A.; Buller, Christopher E.; Calkins, Hugh; Fleisher, Lee A.; Freeman, William K.; Froehlich, James B.; Kasper, Edward K.; Kersten, Judy R.; Robb, John F.; Valentine, R. James

doi:10.1016/j.jacc.2009.07.004

Cited by 122 publications

(44 citation statements)

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“…Im Gegensatz dazu findet sich in der aktuellen Leitlinie der amerikanischen kardiologischen Gesellschaften 2009 (AHA/ACC) keine entsprechend eindeutige Empfehlung mehr [15]. Demnach kann der perioperative Einsatz lediglich erwogen werden bei Patienten mit hohem kardialem Risiko vor Hochrisikooperationen.…”

Section: C1 Kreislaufwirksame Pharmakaunclassified

“…Demnach kann der perioperative Einsatz lediglich erwogen werden bei Patienten mit hohem kardialem Risiko vor Hochrisikooperationen. Übereinstimmend raten sowohl die europäische als auch die amerikanische Leitlinie von einer präoperativen Neueinstellung grundsätzlich ab, wenn eine Dosistitration des β-Rezeptorenblockers nach Herzfrequenz und Blutdruck mit ausreichendem Abstand zur Operation nicht gewährleistet ist [7,15]. Ob 7 Kalzium(Ca 2+)-Antagonisten das perioperative "Outcome" verbessern, ist unklar.…”

Section: C1 Kreislaufwirksame Pharmakaunclassified

“…für mindestens 12 Monate (Patienten mit DES) mit ADP-Antagonisten (z. B. Clopidogrel, 75 mg/Tag) behandelt werden sollten [7,15].…”

Section: C5 Thrombozytenaggregationshemmerunclassified

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Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen

2011

Urologe

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Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

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Section: C1 Kreislaufwirksame Pharmakaunclassified

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Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen

2011

Urologe

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“…Current guidelines support a relatively wide indication for the perioperative use of β-blockers in patients undergoing major vascular surgery to reduce the incidence of peri- and postoperative cardiac complications, including sudden death, angina and MI [43]. Indeed, elevated levels of catecholamines during and after surgery are a well-known phenomenon, and in association with hormonal and blood rheology changes and the effects of anesthetics, catecholamines are the mechanisms responsible for cardiovascular complications [44].…”

Section: Perioperative Use Of β-Blockers In Copdmentioning

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Is the Use of β-Blockers in COPD Still an Unresolved Dilemma?

Foresi

Cavigioli²,

Signorelli³

et al. 2010

Respiration

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β-Blockers are competitive antagonists at β-adrenergic receptors (β-AR) and are a life-saving form of treatment in different cardiovascular diseases (CVD). Despite current guidelines supporting the use of selective β₁-blockers in patients with CVD and especially in heart failure (HF), they are still largely underused, mostly as a consequence of the presence of chronic obstructive pulmonary disease (COPD). In primary care, prevalence of COPD in patients with HF is approximately 25%, and it will rise in the next years. In the general population, only 20% of COPD patients with HF are treated with β-blockers. β-Blockers may result in pulmonary adverse effects that are relevant to COPD patients. Bronchoconstriction may be the consequence of: absence of cardioselectivity; loss of cardioselectivity at high doses, and unopposed stimulation of cholinergic muscarinic M₂ receptors. The concern of inducing bronchospasm is the more likely explanation of a poor prescription of β-blockers in patients with CVD also suffering from COPD. However, under carefully controlled conditions, which include close monitoring of lung function and appropriate selection of the drug and titration of the dose on a case-by-case basis, selective β₁-blockers can be safely administered to most patients with COPD. Pneumologists and cardiologists should develop a detailed and standardized protocol to guide the use of selective β₁-blockers in everyday practice, which could significantly reduce the physicians’ mistrust of β-blockers in COPD patients.

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“…Die 2009Revision der ACC/AHA Leitlinien von 2007 betrifft sogar aus schließlich dieses Thema [3,5]. Obwohl sich beide Leitlinien auf dieselbe Litera tur beziehen [und hier insbesondere auf die Ergebnisse der "Perioperativeische micevaluation" (POISE)Studie; [4]], fallen die Empfehlungen erstaunlicher weise unterschiedlich aus (.…”

Section: Perioperative β-Blockertherapieunclassified

Perioperatives kardiales Vorgehen bei nichtkardiochirurgischen Eingriffen

Priebe

2010

Anaesthesist

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Since November 2009, the first European guidelines on perioperative cardiac care for non-cardiac surgery have been published by the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). The following article will describe the most important recommendations of these guidelines and discuss the clinically relevant differences to the corresponding recommendations of the current guidelines of the American College of Cardiology (ACC) and the American Heart Association (AHA).

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2009 ACCF/AHA Focused Update on Perioperative Beta Blockade

Cited by 122 publications

References 53 publications

Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen

Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen

Is the Use of β-Blockers in COPD Still an Unresolved Dilemma?

Perioperatives kardiales Vorgehen bei nichtkardiochirurgischen Eingriffen

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