Perioperative Beta Blockade Guidelines

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Perioperative Beta Blockade Guidelines

• (PBB)

2
History

• Mangano showed that IV atenolol prior surgery and
  postoperatively until discharge reduced
  postoperative mortality significantly out to 2
  years.

3
History

• Poldermans showed that perioperative bisoprolol
  reduced postoperative myocardial events
  significantly.

4
History

• Dr. David Brown, Professor and Head, Department
  of Anesthesia appointed a work group in the
  Spring of 2003. The group met several times and
  crafted guidelines specific to UIHC. The
  guidelines were approved by the Surgical Services
  Subcommittee, the Nursing Board and the
  Professional Practices Subcommittee.

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Where can I find the Guidelines?

• http//policies.uihc.uiowa.edu/Governing20Body20
  Directives/SectionV/V.43.pdf
• Go to policies.uihc.uiowa.edu
• Click on Section V--Patient Issues
• Click on V.43
• You will need Acrobat Reader

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Action

• The guidelines are to be implemented immediately.
  
• An A1-a (Doctors Orders) has been prepared for
  use in and will be stocked in the Presurgical
  Evaluation Clinic, the Operating Rooms and the
  Post Anesthesia Care Unit.

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Who is eligible for PBB?

• Any one of the following
• Prior MI
• Typical Angina
• Positive thallium scan
• Positive graded treadmill test
• Abnormal coronary angiograms
• Other documentation of coronary artery Dz

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Who is eligible for PBB?

• Any 2 of the following
• Age gt 50
• Hypertension
• Current smoking
• Diabetes
• Hyperlipidemia

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Preoperatively

• Atenolol 25 mg every morning PO
• Start 7 days preoperatively preferably
• Goal is to get heart rate lt 60 or systolic BP
  less than 110
• This med will likely be ordered in the PEC
• If PBB was not started preoperatively and pt is
  eligible, may start IV metoprolol in the holding
  area

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Intraoperatively

• Metoprolol IV push as necessary
• Goal is HR lt 60 or SBP lt 110

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Postoperativelyin monitored units

• Metoprolol 2-5 mg IV push for HR gt 60 or SBP gt
  110
• May repeat every 10 minutes
• Not to exceed _____ doses
• Order most likely written by Anesthesia in PACU

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Postoperativelyin non-monitored units

• Metoprolol (not to exceed 10mg) in 50 ml NS
  infused over 30 minutes for HR gt 70 and SBP gt 110
• May repeat every 1 hour not to exceed ____doses
  per day (maximum of 4)
• Start Atenolol when patient is able to tolerate
  PO meds
• Order most likely written by Anesthesia in PACU

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Home Bound

• If patient is discharged prior to 7 days
  following procedure, surgical resident will write
  prescription to continue PBB for at least 7 days
  following procedure if not indefinitely

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Questions?

• Page the anesthesia chief resident on beeper 3911
  for guideline questions.