The Effect of Bisoprolol on Perioperative Mortality and Myocardial Infarction in High-Risk Patients Undergoing Vascular Surgery

Surgical Technique and Peripheral Artery Disease

“…Early studies suggested that ␤-blockade was associated with decreased mortality and cardiac complications in patients undergoing noncardiac surgery. 19,20 A retrospective study of 560 patients who underwent open vascular surgery showed a reduced rate of perioperative MI and death among patients receiving a ␤-blocker. 21 In PREVENT III, among patients not receiving a ␤-blocker before undergoing infrainguinal bypass for CLI, the adjusted odds ratio of a perioperative MI was 3.9 times higher in those with a history of advanced CAD compared with those with no such history.…”

Changing the Practice of Perioperative Cardioprotection

“…[1][2][3][4] Adoption was speedy because the potential benefit of perioperative ␤-blockers was large, 5 with few attendant risks; rapid adoption was further bolstered because perioperative ␤-blockers were having the same effects in surgical patients that they had in other patients with coronary artery disease (eg, reducing the risk of death from coronary ischemia). By 2005, the majority of the evidence supporting perioperative ␤-blockade was derived from highly screened patient populations undergoing specific procedures (eg, vascular surgery) and receiving agents (eg, intravenous atenolol, oral bisoprolol) not widely available in the United States (Table).…”

“…As much as a month beforehand may be best. 2 After surgery, it is critical that focus shifts to continuing ␤-blockers 16,17 appropriately, a process that requires watching ␤-blocked patients carefully after surgery to assess not only for cardiac events but also for infection, pain, hypovolemia, or bleeding. The careful clinician should use his or her best judgment in titrating or discontinuing ␤-blockers as situations dictate, ensuring that, if discontinued, ␤-blockers are restarted as soon as unstable issues are resolved and ensuring that ␤-blockers are a part of the discharge medication list.…”

Perioperative medikamentöse Kardioprotektion

“…Das Spektrum reicht hierbei von einem Beginn einer i.v.Therapie 30 min präope rativ [41,76] über den Beginn einer oralen Therapie ab dem Vorabend oder am Ope rationstag [34,72,81] bis zu einem Thera piebeginn mehr als einen Monat vor der Operation [55,57]. Für die orale Applika tion wurden üblicherweise lang wirksame Präparate einmal und kurz wirksame 2 mal täglich verabreicht [62].…”