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Cardiovascular Perspectives

Changing the Practice of Perioperative Cardioprotection

Perioperative β-Blockers After POISE (PeriOperative ISchemic Evaluation)

Andrew D. Auerbach, MD, MPH

From the Division of Hospital Medicine, University of California San Francisco.

Correspondence to Andrew D. Auerbach MD, MPH, UCSF Department of Medicine Hospitalist Group, 505 Parnassus Ave, Box 0131, San Francisco, CA 94143-0131. E-mail ada@medicine.ucsf.edu

Key Words: coronary disease • morbidity • mortality • prevention • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
For the past decade or more, use of perioperative β-blockers was considered a safe and effective approach to reducing the risk of cardiac complications of surgery in a broad spectrum of patients undergoing noncardiac surgery. This initial sentiment was supported by a fairly small number of randomized trials studying a fairly small number of patients. In the past 5 years, however, evidence has been accumulating to suggest that β-blockers were, at the least, ineffective at reducing cardiac events, with the recent PeriOperative ISchemic Evaluation (POISE) study suggesting that the use of perioperative β-blockers produced net harm in surgical patients.

The publication of POISE, therefore, should prompt a fairly substantial change in the approach to using β-blockers in the patient undergoing noncardiac surgery. After POISE, and until more evidence accumulates, the use of β-blockers should be limited primarily to those patients who are on them lifelong or who are on them already. After surgery, the drug should be titrated carefully according to the patient’s clinical situation and continued through discharge.

	Come in, the Water’s Fine: Perioperative β-Blockers 1995 to 2005

 
Between 1996 and 2005, the practice of using β-blockers to prevent postoperative cardiac complications was adopted on the basis of a small number of randomized trials and reviews.^1–4 Adoption was speedy because the potential benefit of perioperative β-blockers was large,⁵ with few attendant risks; rapid adoption was further bolstered because perioperative β-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, . . . [Full Text of this Article]

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