Perioperative Care: A Review of Guidelines and Recommendations—Part 2 Peri- and Postoperative Care

β-Blockers The benefits of perioperative continuation of β-blockers in patients who take them chronically have been well documented, and a recommendation for continuation is included in the guidelines set forth by the American College of Cardiology (ACC), together with the American Heart Association (AHA).1 A study of more than 8000 patients from the Surgical Care and Outcomes Assessment Program in Washington State demonstrated that abrupt perioperative withdrawal of β-blockers was associated with a 2-fold increase in 90-day adverse cardiac events.2 Interestingly, for high-risk patients not already taking β-blockers, perioperative initiation of therapy was demonstrated in a large randomized-controlled trial to increase the risk of stroke and perioperative mortality.3 Therefore, patients taking chronic β-blockers should be instructed to continue these medications without interruption perioperatively, but β-blockers should not be started in high-risk patients with the sole intent of decreasing perioperative complications.1