Cardiovascular Medicine Book

Congestive Heart Failure

Coronary Artery Disease

Electrocardiogram

Examination

Hyperlipidemia

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Pericardial Disorders

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Perioperative Beta Blocker

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  1. See Also
    1. Preoperative Examination
  2. Indications
    1. See Preoperative Cardiovascular Evaluation
    2. Cardiac Risk Factors and not Low Risk Surgery
  3. Efficacy
    1. Reduces cardiac perioperative mortality by 65%
  4. Adverse Effects
    1. May increase risk of Cerebrovascular Accident
    2. References
      1. Rosenman (2008) Mayo Selected Topics in Internal Medicine, Lecture
  5. Protocol
    1. Start Beta Blocker in advance of surgery
      1. Optimal if two weeks or more before surgery
      2. Titrate dose to Heart Rate <70 beats per minute
    2. Continue Beta Blocker for 14 days after surgery
    3. Indications to use half dose of Beta Blocker
      1. Small, elderly or frail patient
      2. Systolic Blood Pressure < 100 mmHg
      3. Heart Rate <65 beats per minute
    4. Indications to hold dose
      1. Heart Rate <50 beats per minute
  6. Preparations
    1. Modify dosing as per protocol above
    2. Metoprolol (preferred)
      1. Oral: 50 mg PO bid until 14 days post-surgery
        1. Use 25 mg PO bid if indicated per protocol above
      2. IV: 10 mg IV q6 hours if unable to take oral
        1. Use 5 mg IV q6h if indicated per protocol above
        2. Convert to oral when able
        3. Continue for 14 days post-surgery
    3. Atenolol (older protocol, see protocol above)
      1. Initial dose: 5 mg IV 30 minutes before surgery
      2. Next dose: 5 mg IV immediately after surgery
      3. Maintenance: 50-100 mg PO qd for 7 days
    4. Bisoprolol (older protocol, see protocol above)
      1. Dose: 5-10 mg PO qd
      2. Start 7 days before surgery
      3. Continue for 30 days after surgery
    5. References
      1. Poldermans (1999) N Engl J Med 341:1789

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