20 Oct 09
Perioperative β blockade, discontinuation, and complications: Do you really know it when you see it?
By M London
Anesthesiology 2009;111:690-694
Attempting to articulate his thoughts on the legal definition of obscenity in the 1960s, Supreme Court Justice Potter Stewart, opined I know it when I see it. This approach, celebrated at that time as intuitive and pragmatic, was one he later recanted. Clinicians take a similar approach to situations that are often more complex than they appear. In this issue of Anesthesiology, van Klei et al. report an analysis of patterns of perioperative β-blocker prescription in patients undergoing orthopedic surgery.1 They conclude that their results provide confirmatory evidence to one of the two class 1 recommendations for perioperative β-blockade of the American College of Cardiology/American Heart Association Perioperative Evaluation Guidelines Committee, paraphrased by the authors as not to withdraw β-blocker therapy. As the current guideline comprise only a single paragraph with three literature citations, a closer look at this issue appears timely.