• Martin J London, Kamal M F Itani, Albert C Perrino, Peter D Guarino, Gregory G Schwartz, Francesca Cunningham, Stephen S Gottlieb, and William G Henderson.
• Department of Anesthesia and Perioperative Care, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA.
• J. Cardiothorac. Vasc. Anesth. 2004 Feb 1; 18 (1): 14-24.

ObjectiveTo delineate clinician opinion on the efficacy, safety, and logistics of perioperative beta-adrenergic blockade for patients undergoing noncardiac surgery.DesignSurvey of opinions and clinical practices.SettingInternet-based survey form.ParticipantsMembers of the Associations of Veterans Affairs Anesthesiologists and Surgeons and chiefs of cardiology in centers with surgical programs.InterventionsNone.Measurements And Main ResultsOne hundred twenty-seven responses from 62 Veterans Affairs Medical Centers in 35 states (57 anesthesiologists, 45 surgeons, 25 cardiologists) were analyzed. Ninety-two percent agreed that it is effective in reducing short-term adverse outcomes, declining to 60% for long-term outcome. There was greater enthusiasm for its use in patients with known coronary artery disease (87%) than in patients with risk factors only (72%). Although 66% considered it efficacious in vascular surgery, only 30% were convinced it was for nonvascular surgery (with a similar distribution for safety in these settings). Preoperative use was favored (94%), with most physicians favoring use within 1 week of surgery (52%). Most favored 1 to 2 weeks of postoperative therapy (43%), with the remainder favoring shorter (19%) or longer (35%) durations. Although 71% of clinicians reported frequent use in their practice, most believed its use was largely informal by their colleagues (83%) and rarely based on a formal clinical pathway (13%).ConclusionA wide range of opinions by clinicians regarding the efficacy, safety, and logistics of perioperative beta-adrenergic blockade was encountered, suggesting need for additional clinical research and centralized efforts at increasing compliance with existing guidelines.

26 keywords...

hide…