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Perioperative use of beta-blockers remains low: experience of a single Canadian tertiary institution

[L’usage périopératoire des bêta-bloquants n’est pas fréquent : l’expérience d’un seul centre tertiaire canadien]

Ivan Rapchuk, MD^*, Shannon Rabuka, MD FRCPC and Marcello Tonelli, MD SM FRCPC

^* From the Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia;
the Department of Anesthesia, and
Medicine, University of Alberta, Edmonton, Alberta, Canada.

Address correspondence to: Dr. Marcello Tonelli, University of Alberta, 7-129 Clinical Science Building, 8440 - 112 Street, Edmonton, Alberta T6B 2B7, Canada. Phone: 780-407-8716; Fax: 780-407-7878; E-mail: mtonelli{at}ualberta.ca

Background: Perioperative beta-blockade appears to reduce morbidity and mortality in non-cardiac surgery, and is recommended by published guidelines. This study explores the frequency of perioperative beta-blockade and identifies factors limiting its use.

Methods: We conducted a prospective analysis of consecutive patients seen by anesthesiologists before major non-cardiac surgery in a single month. Because not all patients undergoing major surgery were seen preoperatively by anesthesiologists, we also performed a retrospective analysis of patients who recently underwent such surgery. Data were collected on demographic information, cardiovascular risk factors, beta-blocker use, and perceived contraindications/barriers to beta-blocker use, using a validated instrument.

Results: The prospective phase studied 222 patients preoperatively, of whom 96 were suitable candidates for perioperative beta-blockade by the American College of Physician guidelines. The retrospective phase studied 200 patients, of whom 63 were suitable candidates, and assessed pre- and postoperative use of beta-blockade. 40.6% and 38.1% of suitable patients received preoperative beta-blockade in the two phases, respectively. Findings were similar in those undergoing vascular surgery, suggesting that perception of perioperative risk did not influence the decision to use beta-blockade. Beta-blockers were not prescribed preoperatively because of lack of knowledge about contraindications to beta-blockade, and anesthesiologist reluctance to prescribe oral medication to outpatients.

Discussion: Use of preoperative beta-blockade among suitable candidates appears to be approximately 40%. Anesthesiologists started preoperative beta-blockers infrequently even in patients without contraindications. These findings suggest that educating anesthesiologists about the perioperative use of beta-blockade may increase the use of this potentially beneficial strategy.

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