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A1278
October 26, 2005 9:00:00 AM - 11:00:00 AM Hall C4 |
| Anesthesia Information System Demonstrates Decreasing Use of Intraoperative Beta Blockers in Patients "at Risk" for CAD Undergoing Non-Cardiac Surgery |
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Michael M. Vigoda, M.D., M.B.A., David A. Lubarsky, M.D., M.B.A., Eliane Varga, M.D., Sally Lin, M.D. Anesthesia, University of Miami, Miami, Florida, United States |
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INTRODUCTION: Studies have demonstrated that perioperative beta blockers usage may reduce mortality and morbidity in patients with established or suspected CAD1,2. Beta blockers can play an important role in the prevention of perioperative ischemic episodes. Previous investigators have described the use of Anesthesia Information Systems to monitor the low rate of preoperative beta blockers usage in patients with cardiac risk factors undergoing non-cardiac surgery3. There have been no reports on the patterns of intraoperative administration patterns of beta blockers in these patients. METHODS: We considered patients to be “at risk” for CAD if they had ≥2 risk factors described by Mangano2 (age ≥65; current smoker; hypercholesterolemia; hypertension; diabetes mellitus) Custom data queries were run using Structured Query Language (SQL) on all patients having non-cardiac surgery at a large academic tertiary care hospital between November 2003 and December 2004. We analyzed patterns of (a) preoperative beta blocker therapy and (b) intraoperative administration. RESULTS: There were 2,064 patients who were considered to be “at risk” for CAD (535 on chronic therapy; 1529 not on chronic therapy). There was a relatively constant usage (approximately 25%) of preoperative chronic beta blocker therapy in this group of patients (Figure 1). There was a striking downward trend in the pattern of intraoperative usage of beta blockers during the 14 month period (Figure 2). CONCLUSION: Anesthesia Information Systems can help monitor the medication usage both pre and intraoperatively. The perception among anesthesiologists is that perioperative usage is beneficial. Nonetheless, in our practice, we saw a decline in the proportion of patients who received intraoperative beta blockers. This decrease was seen in both patients who were on chronic preoperative therapy as well as those who were not. In addition, the decrease in both groups was similar in magnitude for each month. We speculate that after the ASA meeting there was increased awareness of the need for perioperative beta blocker usage, resulting in higher initial levels. Our experience suggests that ongoing education may be an effective intervention in improving patient care. REFERENCES: [1]Mangano et al. Effect of Atenolol on Mortality and Cardiovascular Morbidity after Noncardiac Surgery N Engl J Med 1996; 335: 1713-20 [2] Poldermans et al. The Effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. N Engl J Med 1999;341:1789-94 [3] Vigoda et al. Anesthesia Information System Helps Identify Missed Opportunities for Perioperative Beta Blockade, Las Vegas 2004 ASA Annual Convention (A-1378)[figure1][figure2] Anesthesiology 2005; 103: A1278 |
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