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When Should Perioperative -Blockers Be Discontinued?

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To the Editor: In their review of perioperative -blockade for noncardiac surgery, Drs Auerbach and Goldman¹ may have created some confusion about the potential for complications of withdrawal of -blockade. They summarize an article by Shammash et al² as follows: "A recent prospective observational study noted that patients who were not receiving -blockers long-term but who discontinued perioperative use immediately after surgery had an increased risk for postoperative myocardial infarction."

In fact, this article reports a retrospective review of medical records of patients who received -blockers before surgery. Patients whose -blockade was continued into the postoperative period were compared with patients whose -blockade was not reinstituted. Most of the regimens described to date for perioperative -blockade extend significantly into the postoperative period.^3-4 Although there is the potential for a rebound reaction following the institution of perioperative -blockade, the literature reviewed does not address that situation. In particular, it remains unclear . . . [Full Text of this Article]

RELATED ARTICLE

-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Scientific Review
Andrew D. Auerbach and Lee Goldman
JAMA. 2002;287(11):1435-1444.
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