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Canadian Journal of Anaesthesia

, Volume 50, Issue 2, pp 131–136 | Cite as

Successful implementation of perioperative betablockade utilizing a multidisciplinary approach

  • Samuel Armanious
  • David T. Wong
  • Edward Etchells
  • Patrick Higgins
  • Frances Chung
General Anesthesia

Abstract

Purpose

To describe how we implemented a protocol for perioperative beta-blockade in patients with or at risk of coronary artery disease (CAD) undergoing major non-cardiac surgery and to present our results.

Methods

After institutional approval, from May 1999 to April 2001, patients with surgical and medical indications (CAD as indicated by previous myocardial infarction, typical angina or atypical angina with a positive stress test or at least two risk factors for CAD: age 65 yr, hypertension, smoking, high cholesterol, diabetes mellitus) for perioperative beta-blockade were identified preoperatively by anesthesiology and referred to the General Internal Medicine Service (MED), MED initiated patients on outpatient beta-blockers. The intraoperative anesthetic management was left to the discretion of the anesthesiologist. In the postanesthesia care unit (PACU), patients received iv metoprolol according to hemodynamic criteria, Postoperatively, patients were followed by MED for adverse cardiac events.

Results

Sixty-nine patients received perioperative beta-blockade, Preoperatively, 60% were started on metoprolol, 39% on atenolol and 1% on proprandol. In PACU, 42%, 9% and 38% of patients were given iv metoprolol 0, 5 and 10 mg respectively. One patient was given glycopyrrolate in the PACU for bradycardia and none received vasoactive or inotropic agents. Three patients (4.3%) had postoperative cardiac events.

Conclusions

With close collaboration between anesthesiologists, internists, PACU nurses and family physicians, a strategy for perioperative beta-blockade was implemented successfully in patients with cardiac risks. Beta-blockade was associated with few side effects and morbidities.

Keywords

Metoprolol Postoperative Cardiac Event PACU Nurse Personnel Infirmier Stress Myocardial Perfusion Scan 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

L’application réussie d’un bêta-blocage périopératoire par une approche multidisciplinaire

Résumé

Objectif

Décrire la mise en application d’un protocole de bêtablocage périopératoire chez des patients atteints, ou à risque, de coronaropathie (CP) devant subir une intervention non cardiaque majeure, et présenter nos résultats.

Méthode

Ayant reçu l’approbation de l’institution, les anesthésiologistes ont identifié, entre mai 1999 et avril 2001, les patients admissibles à un bêta-blocage périopératoire seion des indications médicales et chirurgicales (CP révélée par un infarctus du myocarde antérieur, angine typique ou atypique démontrée par une épreuve d’effort positive ou au moins deux facteurs de risque de CP : âge = 65 ans, hypertension, tabagisme, cholestérol élevé, diabète) et les ont été dirigés vers le General Internal Medicine Service (MED). Le MED a d’abord administré les bêta-bloqueurs en clinique externe. L’anesthésiologiste s’est chargé de la période peropératoire. À la salle de réveil (SDR), on a administré du métoprolol iv seion les critères hémodynamiques. Le MED a assuré un suivi postopératoire en raison de complications cardiaques possibles.

Résultats

Soixante-neuf patients ont reçu des bêta-bioqueurs périopératoires. Avant l’opération, 60% d’entre eux ont d’abord eu du métoprolol, 39% de l’aténoiol et 1% du propranolol. À la SDR, 42%, 9% et 38% des patients ont respectivement reçu 0, 5 et 10 mg de métoprolol iv. À la SDR, un patient a reçu du glycopyrrolate pour une bradycardie, mais aucun agent vasoactif ou inotrope n’a été donné. Trois patients (4,3%) ont eu des problèmes cardiaques postopératoires.

Conclusion

La collaboration entre anesthésiologistes, intemistes, personnel infirmier de la SDR et omnipraticiens a permis la mise en œuvre réussie d’une stratégie de bêta-blocage périopératoire chez des patients présentant des risques cardiaques. Peu de morbidité ou d’effets secondaires ont été associés au bêta-blocage.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Samuel Armanious
    • 1
  • David T. Wong
    • 1
  • Edward Etchells
    • 2
  • Patrick Higgins
    • 1
  • Frances Chung
    • 1
  1. 1.Departments of AnesthesiologyToronto Western Hospital, University Health Network, University of TorontoTorontoCanada
  2. 2.Division of General Internal Medicine and Clinical EpidemiologyToronto Western Hospital, University Health Network, University of TorontoTorontoCanada

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