Perioperative beta-blockade

Overview

Adverse cardiac outcome continues to be an important cause of perioperative morbidity and mortality in non-cardiac surgery. This is related to the high prevalence of coronary artery disease in the ageing surgical population. Beta-blockers have proven useful and efficatious in the treatment of perioperative myocardial ischaemia and arrhytmias. After early studies had suggested that a prophylactic perioperative beta-blockade could also reduce perioperative and long-term morbidity and mortality, the administration of beta-blockers to patients with coronary artery disease or its risk factors undergoing major non-cardiac surgery is now recommended in published guidelines. However, a recent meta-analysis as well as several new studies did not confirm the postulated beneficial effects of perioperative beta-blockade and gave rise to a lively discussion. Until the conclusions of the ongoing large trials in the next two years and better evidence are known, the decision to start prophylactic perioperative beta-blockade remains at the discretion of the attending physicians. This decision should be based on the patient’s risk, type of surgery and a consideration of potential interactions and side-effects of the selected beta-blocker.

Key words:
beta-blockers – non-cardiac surgery – cardiac risk – complications – evidence