The ACC/AHA updated the recommendations for peri-operative beta blockers in non-cardiac surgery patients. The only Class I recommendation is to continue beta blockers in those already on them. Class IIa include starting beta blockers on those undergoing vascular surgery (with known CAD, ischemia, or >1 risk factor*), or intermediate risk surgery with > 1 risk factor. Class IIb (uncertainty of benefit) for those undergoing intermediate risk with <1 risk factors or vascular surgery with 0 risk factors. They emphasizethat beta blockers should be titrated to goal BP/HR effect. (*risk factors = h/o ischemia, h/o CHF, h/o CVA, h/o DM, or h/o creatinine>2mg/dL) (guideline)
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.