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Auerbach AD, Goldman L. β-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Clinical Applications. JAMA. 2002;287(11):1445–1447. doi:10.1001/jama.287.11.1445
Author Affiliations: Department of Medicine, University of California, San Francisco.
Recent studies suggest that β-blockers administered perioperatively
may reduce the risk of adverse cardiac events and mortality in patients who
have cardiac risk factors and undergo major noncardiac surgery. The objective
of this article is to provide practicing physicians with examples of perioperative β-blocker
use in practice by using several hypothetical cases. Although current evidence
describing the effectiveness of perioperative β-blockade may not address
all possible clinical situations, it is possible to formulate an evidence-based
approach that will maximize benefit to patients. We describe how information
from several sources can be used to guide management of patients with limited
exercise tolerance, those at highest risk for perioperative cardiac events,
patients who are taking β-blockers long-term, and those with relative
contraindications to β-blockade. Even though fine points of their use
remain to be elucidated, perioperative β-blocker use is important and
can be easily applied in practice by any physician involved with the care
of patients perioperatively.
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