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Steven M. Frank, MD
Johns Hopkins University School of Medicine Baltimore, Md

JAMA. 1997;278(7):545-546.

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In Reply.

—Dr Berry raises the important point of whether preoperative β-adrenergic blocker use was an effect modifier in our study and suggests that further analysis of the data might improve our understanding of the mechanism for hypothermia-induced perioperative cardiovascular complications.

Approximately 30% of the patients in our study were receiving β-adrenergic blockers preoperatively. Patients taking β-blockers had an approximate 2-fold increase in relative risk for early postoperative morbid cardiac events. Several reasons might explain this finding, and we have further analyzed our data to investigate these possibilities. First, it appears that the subgroup of patients using ²-blockers had more advanced cardiovascular disease (Table). Second, because oral medication usually was withheld in the immediate postoperative period, it is . . . [Full Text PDF of this Article]

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