Is There Any Reason To Withhold β Blockers from High-risk Patients with Coronary Artery Disease during Surgery?

Intraoperative Cardiac Emergencies

“…B-adrenoreceptor blockers should be administered to patients with 1 or more factors that are known to be associated with a higher perioperative cardiac risk. 15 Although perioperative b-blockers have been proved to decrease the risk of MI, this benefit is accompanied by an increased risk of stroke, hypotension, and bradycardia postoperatively. Practitioners must remain vigilant to titrating dose to effect.…”

Perioperative Strategien zur Regulierung des Sympathikotonus

“…Dies gilt insbesondere für Patienten mit anamnestischer Herzinsuffizienz. In einem kürzlich publizierten Editorial, begleitend zu einem Artikel von London et al [49] über die physiologischen Grundlagen und klinischen Kontroversen der perioperativen β-Blockade, empfahlen Kertai et al [38] die breite Anwendung einer perioperativen β-Blockade bei allen chirurgischen Patienten mit sogar nur einem einzigen koronaren Risikofaktor sowie eine langfristige Fortführung der perioperativen β-Blockade nach der Operation. Es muss hier betont werden, dass derart weitreichende Empfehlungen auf solideren Grundlagen beruhen müssen, namentlich auf randomisierten kontrollierten Studien.…”

Ideal peri‐operative management of patients with cardiovascular disease: the quest continues

“…Several prospective and retrospective studies have shown that peri-operative beta blockade reduces morbidity and mortality in patients with cardiovascular risk factors [31,32], or documented inducible myocardial ischaemia undergoing major non-cardiac surgery [33][34][35], and it has been suggested that they are administered to almost all patients undergoing major surgery [36]. Studies showing benefit from peri-operative beta blockade have logically assumed that reduction of heart rate to below a critical threshold value ................................................................................................................................................................................................................... associated with myocardial ischaemia is important [31][32][33]37].…”