Should my outpatient center have a β-blocker protocol?

Current Opinion in Anaesthesiology

Volumn 20, Issue 6, 2007, Pages 526-530

  Fleisher, Lee A ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

adrenergic blockade; Guidelines; Myocardial infarction; Myocardial ischemia

Indexed keywords

ATENOLOL; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; METOPROLOL;

AMBULATORY SURGERY; CARDIOVASCULAR RISK; CORONARY ARTERY DISEASE; DRUG EFFICACY; DRUG WITHDRAWAL; EXERCISE TEST; HEART INFARCTION; HUMAN; MEDICAL SOCIETY; OUTPATIENT DEPARTMENT; PRACTICE GUIDELINE; PRIORITY JOURNAL; REVIEW; SURGICAL TECHNIQUE; VASCULAR SURGERY;

ADRENERGIC BETA-ANTAGONISTS; AMBULATORY CARE FACILITIES; AMBULATORY SURGICAL PROCEDURES; CLINICAL PROTOCOLS; EVIDENCE-BASED MEDICINE; HUMANS; MYOCARDIAL ISCHEMIA; PERIOPERATIVE CARE; PRACTICE GUIDELINES AS TOPIC; VASCULAR SURGICAL PROCEDURES;

EID: 36148945640     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/ACO.0b013e3282f19339     Document Type: Review

References (27)

1. Devereaux PJ, Beattie WS, Choi PT, et al. How strong is the evidence for the use of perioperative beta blockers in noncardiac surgery? Systematic review and meta-analysis of randomised controlled trials. BMJ 2005; 331: 313-321.
2. Fleisher LA. Perioperative beta-blockade: how best to translate evidence into practice. Anesth Analg 2007; 104:1-3. This editorial outlines the current impetus to develop guidelines for perioperative β-blockade and puts these guidelines in perspective with regard to actual care.
3. Wiesbauer F, Schlager O, Domanovits H, et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity: a systematic review and meta-analysis. Anesth Analg 2007; 104:27-41. This is an outstanding meta-analysis of both the risks and benefits of perioperative β-blocker trials.
4. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2006 guideline update on perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and Biology. Circulation 2006; 113:2662-2674. Guidelines from the AHA/ACC on the use of perioperative β-blocker therapy are presented.
5. Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006; 113:2363-2372. These guidelines from the AHA/ACC define the indications for long-term β-blocker therapy to prevent morbidity and mortality in those patients with coronary and peripheral vascular disease.
6. Mukherjee D, Lingam P, Chetcuti S, et al. Missed opportunities to treat atherosclerosis in patients undergoing peripheral vascular interventions: insights from the University of Michigan Peripheral Vascular Disease Quality Improvement Initiative (PVD-QI2). Circulation 2002; 106:1909-1912.
7. Nass CM, Allen JK, Jermyn RM, Fleisher LA. Secondary prevention of coronary artery disease in patients undergoing elective surgery for peripheral arterial disease. Vasc Med 2001; 6:35-41.
8. Warner MA, Shields SE, Chute CG. Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia. JAMA 1993; 270:1437-1441.
9. Fleisher LA, Pasternak LR, Herbert R, Anderson GF. Inpatient hospital admission and death after outpatient surgery in elderly patients: importance of patient and system characteristics and location of care. Arch Surg 2004; 139:67-72.
10. Fleisher L, Beckman J, Brown K, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 2007 (in press).
11. Prys-Roberts C, Foex P, Biro GP, Roberts JG. Studies of anaesthesia in relation to hypertension. V. Adrenergic beta-receptor blockade. Br J Anaesth 1973; 45:671-681.
12. Hoeks SE, Scholte Op Reimer WJ, van Urk H, et al. Increase of 1-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients. Eur J Vasc Endovasc Surg 2007; 33:13-19. This is one of the few cohort studies that demonstrate the risks associated with perioperative β-blocker withdrawal.
13. Fleisher LA. The preoperative evaluation: an opportunity for education and other strategies to improve care. J Cardiothorac Vasc Anesth 2007; 21:323-324. This editorial outlines the value of preoperative education with respect to β-blocker therapy.
14. Rosenfeld DM, Trentman TL, Hentz JG, et al. Patient understanding of the importance of beta-blocker use in the perioperative period. J Cardiothorac Vasc Anesth 2007; 21:325-329. This cohort study illustrates the lack of understanding by patients on the value of continuing their β-blocker therapy.
15. Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 1996; 335:1713-1720.
16. Poldermans D, Boersma E, Bax JJ, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999; 341:1789-1794.
17. Boersma E, Poldermans D, Bax JJ, et al. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 2001; 285:1865-1873.
18. Lindenauer PK, Pekow P, Wang K, et al. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 2005; 353:349-361.
19. Brady AR, Gibbs JS, Greenhalgh RM, et al. Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial. J Vasc Surg 2005; 41:602-609.
20. Yang H, Raymer K, Butler R, et al. The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J 2006; 152:983-990.
21. Juul AB, Wetterslev J, Gluud C, et al. Effect of perioperative beta blockade in patients with diabetes undergoing major noncardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ 2006; 332:1482. This large, randomized trial of perioperative β-blockade in diabetic patients without documented coronary artery disease did not demonstrate any benefit.
22. Feringa HH, Bax JJ, Boersma E, et al. High-dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients. Circulation 2006; 114:I344-I349. This important cohort study demonstrated the importance of heart rate control on outcome in patients taking β-blocker therapy.
23. Redelmeier D, Scales D, Kopp A. Beta blockers for elective surgery in elderly patients: population based, retrospective cohort study. BMJ 2005; 331:932.
24. McGory ML, Maggard MA, Ko CY. A meta-analysis of perioperative beta blockade: what is the actual risk reduction? Surgery 2005; 138: 171-179.
25. Stevens RD, Burri H, Tramer MR. Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg 2003; 97:623-633.
26. London MJ. Con: Beta-blockers are indicated for all adults at increased risk undergoing noncardiac surgery. Anesth Analg 2007; 104:11-14. This paper is part of a pro/con debate on the value of prophylactic β-blocker therapy.
27. Schouten O, Bax JJ, Dunkelgrun M, et al. Pro: Beta-blockers are indicated for patients at risk for cardiac complications undergoing noncardiac surgery. Anesth Analg 2007; 104:8-10. This paper is part of a pro/con debate on the value of prophylactic β-blocker therapy.