Perioperative beta blockade in noncardiac surgery: a review of the literature.

Perioperative beta blockade has been proven to significantly reduce the incidence of myocardial ischemia and myocardial infarction and of long-term overall mortality related to cardiac events after various surgeries in patients at intermediate or high risk for such events. The major physiologic effects of beta blockers result in a positive balance of myocardial oxygen supply and demand. Although the optimal time frame for initiation of treatment is not clear from the available data, it has been shown that beta blocker therapy is effective when started at least 1 week before the scheduled surgery and continued throughout the postoperative period. The current recommendations for perioperative beta blockade for patients at intermediate and high risk for a perioperative cardiac event are to use a beta1 blocking agent, begin therapy several weeks before a planned operation, titrate the dose to achieve a heart rate of 60 to 70 beats per minute, and taper the dose of the beta blocker after the postoperative period.