Should my outpatient center have a β-blocker protocol?

Lee A. Fleisher

Research output: Contribution to journalReview articlepeer-review


PURPOSE OF REVIEW: Perioperative β-blockade has been advocated by multiple authors and recent guidelines as a strategy to reduce cardiac risk in noncardiac surgery. Knowledge about application of this treatment modality to the ambulatory surgery population is poor. RECENT FINDINGS: Although the initial trial in patients with a positive stress test undergoing major vascular surgery demonstrated significantly fewer perioperative cardiac events among those randomized to perioperative β-blocker therapy, more recent studies in patients without documented coronary artery disease undergoing major noncardiac surgical procedures were unable to demonstrate efficacy. Guidelines from the American Heart Association/American College of Cardiology have been reported and advocated class I recommendations for perioperative β-blockade only for patients previously taking β-blockers and those patients with a positive stress test undergoing vascular surgery. There was insufficient evidence to make a recommendation in low-risk surgery. SUMMARY: Based upon the available evidence and guidelines, patients currently taking β-blockers and undergoing ambulatory surgery should continue these agents and protocols employing this strategy should be beneficial. In patients who are not currently taking β-blockers and in whom long-term therapy is not warranted, current evidence does not support instituting prophylactic therapy in the ambulatory surgery population.

Original languageEnglish (US)
Pages (from-to)526-530
Number of pages5
JournalCurrent Opinion in Anaesthesiology
Issue number6
StatePublished - Dec 2007
Externally publishedYes


  • Guidelines
  • Myocardial infarction
  • Myocardial ischemia
  • β-adrenergic blockade

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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