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October 17-21, 2009 New Orleans, LA Home Abstract Archive Search Abstracts 2009 Session Grid 2009 Meeting Website Policy Statements ASA Website Feedback 
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A-204
2004 |
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| Preoperative Beta-Blockers: Do We Practice What Is Preached? | ||||||||||||||||||||||||||||
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Sherif Assaad, M.D., Muzna Amin, B.A., Paul G. Barash, M.D., David G. Silverman, M.D., Shamsuddin Akhtar, M.D. Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, United States. |
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Introduction: One of the greatest paradoxes in current clinical practice is the application of beta-blockers (BB) to an indicated population. Despite rigorous scientific evidence and a belief by clinicians in the importance of BB to reduce perioperative morbidity and mortality, over 90% of anesthesia departments do not have a protocol for administration of BB pre-, intra- or post-operatively (1). Further, we previously reported that only 50% of patients scheduled for vascular surgery (candidates for BB treatment) actually receive BB therapy prior to their preoperative anesthetic assessment. Of these patients, only 30% had a HR <60 bpm, the goal recommended by the American Heart Association (AHA) (2). Subsequent to reporting that study, the new ACC/AHA Guidelines (2) and concomitant recommendations for preoperative BB by Goldman (3) were published in 2002. We have sought to determine if these publications were followed by an increase in the number of patients receiving BB and in the percentage of patients at the recommended targeted HR (≤60 bpm). Methods: After approval by the institutional IRB, a retrospective review of the pre-anesthetic assessment record was conducted on 197 patients who were scheduled to undergo major vascular surgery between April 2002 and September 2003 (POST publication) and compared to 172 patient who had been scheduled between Jan 2001 and March 2002 (PRE publication) (1) at our tertiary care facility. Pertinent demographic and treatment data were collected from electronically maintained preadmission anesthesia assessment records. Patients were categorized as to whether they received BB preoperatively. The BB and non-BB groups were assessed independently and compared with respect to HR. The incidence of BB use and the HR achieved with such use were compared for the two data intervals. Data are presented as mean ± SD. Statistical analysis by unpaired t-test with Welch correction, and Fisher's exact test; p-value <0.05 considered significant. Results: The PRE-publication [n=172] and the POST-publication [n=197] data revealed no difference in preop demographics (p=NS). No improvement in BB usage was observed between PRE (48%) and POST (49%) (p = NS). Only 22 % of post-guideline BB-patients achieved the target heart rate of 60 bpm, similar to the 29% PRE (Table; p= NS). Discussion: From a pharmacologic management perspective, the use of BB represents a significant failure for the application of the principles of evidence-based medicine. In conclusion, despite publication of (a) authoritative guidelines (b) the newer outcome data and (c) proposed management strategies, there has been no improvement in the peri-operative utilization of BB or achieving the recommended HR. References: 1. Anesth Analg 2003; 96: 1558-65, 2. Anesth Analg 2002; 94: 1052-64 3. JAMA 2002; 287: 1435-44 Anesthesiology 2004; 101: A204 |
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