Is it Time to Discard β-Blockers in Patients Undergoing Noncardiac Surgery?

Prevention of cardiac complications in patients undergoing major surgical or vascular procedures should be approached as the prevention of these complications in other common situations. beta-Adrenoceptor antagonists (beta-blockers) should be indicated in patients who are candidates for those treatments, regardless of whether surgery is performed. Current guidelines include patients with acute coronary syndrome, systolic dysfunction, chronic coronary artery disease (CAD), vascular disease, and diabetes as candidates for long-term beta-blocker therapy. Therefore risk stratification prior to surgery is indeed required to identify patients with existing CAD or myocardial ischemia in order to be able to treat them as such. In addition, beta-blockers may reduce ischemic complications in high-risk patients. However, initiating treatment at high dosages immediately before surgery has been associated with an increased risk of hypotensive strokes.