What’s New in the Patient Safety World

November 2013

Another Assault on Perioperative Beta-Blockers


It seems like we are doing a column on perioperative beta blockers almost every month! Well, not quite but see the list below of all our prior columns on the topic.


Yet another study is questioning the use of beta blockers perioperatively. Dalal and colleagues (Dalal 2013) did a retrospective review of over 750 randomly chosen patients who underwent non-cardiac surgery. Beta-blocker use was found to increase the odds of having an acute coronary event by a factor of 21.76. Beta blocker use was also associated with decompensated heart failure (odds ratio 4.50). Unexpectedly, the risk of arrhythmias was also increased in patients on beta blockers (odds ration 2.28).


But there have been enough retrospective reviews, some concluding that perioperative beta blockers are good and others that they are bad. The controversy is not going to go away until a large randomized controlled trial is undertaken using a beta-blockade regimen that everyone can agree upon.



Our prior columns on perioperative use of beta blockers:


November 20, 2007     “New Evidence Questions Perioperative Beta Blocker Use”

November 4, 2008       “Beta Blockers Take More Hits”

December 2009           “Updated Perioperative Beta Blocker Guidelines”

November 2010           “More Perioperative Beta Blocker Controversy”

November 2012           “Beta Blockers Losing Their Luster?”

May 2013                     “Beta Blocker Debate Just Won’t Go Away”

September 2013            “More Perioperative Beta-Blocker Controversy”







Dalal P, Varma D, Hegazy H. Do Beta-Blockers Increase Perioperative Cardiac Morbidity?  Chest 2013; 144(4_MeetingAbstracts):166A. doi:10.1378/chest.1704913






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