More Beta Blockers, Please

More high-risk surgical patients probably need beta blockers, say researchers from Baystate Medical Center in Springfield, Massachusetts. Upon reviewing the records of 72 patients who developed postoperative myocardial infarction (MI), they found that 70 (97%) could have been identified as being at increased risk for cardiac complications and 58 (81%) were ideal perioperative candidates for beta block-ers. However, only 30 patients actually received beta blockers before having the MI. Beta blockers might have prevented as many as 40% of cases of postoperative MI, the researchers say. Most of the patients were undergoing vascular, general, or orthopedic procedures.

The median interval between surgery and postoperative MI was two days. Four of the ideal candidates who took beta blockers before the onset of MI died; nine patients who did not receive a beta blocker died before experiencing an MI.
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For almost two decades, it has been known that beta-adrenergic blockade can reduce the incidence of myocardial ischemia associated with the stress of surgery. One reason why perioperative beta blockers are not more widely used is that the doctors targeted for education were internists and cardiologists who had previous experience with the drugs. In the case of noncardiac surgery, however, surgeons might be less comfortable prescribing them. The researchers suggest that novel strategies are required, such as co-management of surgical patients by surgeons and internists.