Date: 04 Feb 2010

New practice guidelines for perioperative beta blockade from the United States and Europe: incremental progress or a necessary evil?

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In the latter half of 2009, practice guidelines were published that either dealt exclusively with perioperative beta blockade (as a focused update from the American College of Cardiology Foundation/American Heart Association [ACCF/AHA]) or included beta blockade within new comprehensive perioperative guidelines (from a task force of the European Society of Cardiology [ESC]) (Table 1).1-3 A major impetus was the impact of the controversial PeriOperative Ischemic Evaluation Trial (POISE) that originated in Canada and was coordinated from Canada.4 The results of this trial have been well publicized in a variety of opinion pieces. The study involved over 8,000 high-risk patients, more than 80% of whom had known coronary, peripheral arterial, or cerebrovascular disease and 40% of whom had undergone vascular surgery. In all cases, beta blockade began immediately prior to surgery with orally administered sustained release metoprolol (succinate) that continued for 30 days.5-9 The study’s prima ...

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