Beta-adrenolytic drugs in perioperative risk reduction of non-cardiac surgery in the light of the new guidelines Review article
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Abstract
Current studies suggest that beta-blockers reduce perioperative ischemia and may reduce the risk of myocardial infarction and cardiovascular death in high-risk patients expose to non-cardiac surgery. However, routine administration of higher-dose long-acting metoprolol in betablocker–naïve patients on the day of surgery and in the absence of dose titration in POISE trial was associated with an overall increase in mortality. How should clinicians reconcile these conflicting data? Recently the European Society of Cardiology has issued its first-ever guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery and American Societies of Cardiology issues a focused update of the “ACC/AHA 2007 Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery”, which addresses predominantly the prophylactic use of beta blockers perioperatively. In this article, based on new guidelines, we present current knowledge about effectiveness and safety of betablockers and practical concerns, such as whom, how and when perioperative beta-blocker therapy should be prescribed.
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References
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