Perioperative beta-blockade, 2008: What does POISE tell us, and was our earlier caution justified?

A modern look at hypertension and anaesthesia

“…25 Immediate preoperative beta blockade should therefore be used with caution. 26 The addition of a statin is probably justified in any patient with a high risk of myocardial injury. 27 In high-risk patients, acute hypotension is more dangerous than modest elevations in blood pressure.…”

Perioperative β-Rezeptoren-Blockade

“…Auch die Wahl eines spezifischen β RezeptorenBlockers könnte ursächlich für die zuvor beschriebenen unterschied lichen Langzeitergebnisse sein [44]. In den Arbeiten zum kardialen Risiko in der perioperativen Phase wurden u. a. Meto prolol, Atenolol, Bisoprolol und Esmolol verwendet.…”

New practice guidelines for perioperative beta blockade from the United States and Europe: incremental progress or a necessary evil?

“…In all cases, beta blockade began immediately prior to surgery with orally administered sustained release metoprolol (succinate) that continued for 30 days. [5][6][7][8][9] The study's primary findings posed substantial challenges to each guidelines committee. In particular, the efficacy in reducing cardiac ischemic complications (primarily asymptomatic troponin release, but also the need for revascularization and new atrial fibrillation) was counterbalanced most convincingly by an increased rate of stroke (primarily disabling) and, to a less striking statistical degree, death (primarily from sepsis), with ''clinically significant'' hypotension a strong attributable risk factor in both.…”