Clinical Review: Is the perioperative use of beta-blockers still recommended? A critical review of recent controversies.

The optimal role of beta-adrenergic receptor blockade in the perioperative period remains unclear in patients at risk for cardiovascular events. Cardiovascular complications continue to be the most common cause of perioperative morbidity and mortality, and cardioprotective properties of beta-blockers are widely recognized, yet the results of the clinical trials investigating the use of different beta-blockers in the perioperative period are controversial. The discrepancy might be related to differences in the design of studies, use of different agents, administration by different routes, and continuation for different time intervals. Evidently, perioperative mortality and morbidity seem to be related to heart rate, and the majority of complications are related to beta-blockers' side effects. Based on the observations from different studies, we propose an algorithm for perioperative beta blockade.