Peri-Operative Use of Beta-Blockers: Yes or No?

This chapter focuses on the issues around the peri‐operative use of beta‐blockers. Most peri‐operative myocardial infarctions (MIs) are silent, non‐Q‐wave events that are seen during the first 48 h after surgery when physiological derangements are at their greatest. The mechanisms by which beta‐blockers decrease the incidence of perioperative cardiac complications remain unclear. Most of the positive studies are based on bisoprolol or atenolol, and some of the negative studies used metoprolol. The European Society of Cardiology (ESC) guideline recommends beta‐blockers for patients undergoing high‐risk surgery without reference to the severity of cardiac risk. The ACC/AHA recommends beta‐blockers in high‐risk patients undergoing vascular surgery and are more restrictive. In the 2014 European joint guidelines from ESC/ESA, beta‐blockers are not recommended in patients without clinical risk factors because they may increase the risk of cardiovascular complications. The decision to give beta‐blockers should be made on a case‐by‐case basis after appropriate risk stratification.