21 Sep 08
Perioperative beta-blockade, 2008: What does POISE tell us, and was our earlier caution justified?
By J W Sear, J W Giles, G Howard-Alpe and P Foëx
Br. J. Anaesth. 2008;101:135-138
In the early days of patients presenting for surgery while on beta-blockers, it was customary to stop their administration 2 weeks before elective surgery because of the perceived risk of cardiovascular collapse that could result from blockade of compensatory mechanisms. This view was supported by mostly anecdotal evidence, and seemed illogical as surgery constitutes a high stress situation during which the heart may need to be protected by blockade from the effects of exaggerated sympathetic activity. In 1973, the first detailed haemodynamic study of beta-blockade in surgical patients showed that beta-blockade was compatible with anaesthesia and surgery, reduced the risk of hypertension on laryngoscopy and intubation, and decreased the incidence of both ventricular arrhythmias and myocardial ischaemia.