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A STRATEGY FOR PERIOPERATIVE BETA BLOCKADE IN PATIENTS WITH CARDIAC RISKS

Departments of Anesthesiology and Internal Medicine, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, ON, M5T2S8.

INTRODUCTION

Perioperative beta blockade reduces mortality and morbidity in patients with cardiac risks.¹ The purpose of this study was to implement a protocol for perioperative beta-blockers in patients with definite or at risk of coronary artery disease (CAD) undergoing major non-cardiac surgery in a Canadian tertiary care center.

METHODS

After Institutional Ethics approval, data was collected from May 99 to June 2000 from beta-blockade candidates who fulfilled surgical and medical indications (the presence of CAD as indicated by previous myocardial infarction, typical angina, atypical angina with a positive stress test or with at least two risk factors for CAD: age 65 years, hypertension, smoking, high cholesterol, diabetes mellitus). Patients were recruited by anesthesiologist in the consultation clinic and referred to Internal Medicine for preoperative initiation of beta-blockade and postoperative ward care. Preoperative beta-blocker dosages (metoprolol or atenolol) were titrated to target heart rate and blood pressure. The intraoperative anesthetic management was left to the discretion of the anesthesiologist. In PACU, patients received IV metoprolol in a dose of 0, 5 or 10 mg according to a protocol with set hemodynamic criteria. On the wards, patients were followed by Medicine for adverse cardiac events and beta-blocker titration.

RESULTS

71 patients were referred to Medicine. 31 patients were excluded; beta-blocker contraindicated 2, unstable hemodynamics 7, low medical risk 15, low surgical risk 3 and other reasons 4. Forty patients were studied; peripheral vascular surgery 1, carotid endarterectomy 9, neurosurgery 4, orthopedic 23, general surgery 2, urology 1. Preoperatively, 62.5% were started on metoprolol and 37.5% on atenolol. In PACU, 50%, 10% and 40% of the patients were given IV metoprolol 0, 5 and 10 mg respectively. 15 % were given vasoactive drug intraoperatively and none postoperatively. One (2.5%) developed postoperative hypotension and none had any cardiac event. 26 were discharged home on metoprolol and 13, atenolol.

DISCUSSION

With recruitment in the anesthesia consult clinic, collaboration with medicine and a PACU beta-blockade protocol, perioperative beta-blockade strategy was successfully implemented in patients with cardiac risk. This beta-blockade strategy was associated with few side effects and morbidities.

REFERENCE

1 Mangano DT, Layug EL, Wallace A, Tateo I: Effect of atenolol on mortality and cardiovascularmorbidity after non-cardiac surgery.N Engl J Med1996;335:1713–20.[Abstract/Free Full Text]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Armanious, S. G. Articles by Chung, F. F. Search for Related Content PubMed Articles by Armanious, S. G. Articles by Chung, F. F.