Changing the Practice of Perioperative Cardioprotection

F or the past decade or more, use of perioperative ␤-blockers was considered a safe and effective approach to reducing the risk of cardiac complications of surgery in a broad spectrum of patients undergoing noncardiac surgery. 1 This initial sentiment was supported by a fairly small number of randomized trials studying a fairly small number of patients.In the past 5 years, however, evidence has been accumulating to suggest that ␤-blockers were, at the least, ineffective at reducing cardiac events, with the recent PeriOperative ISchemic Evaluation (POISE) study suggesting that the use of perioperative ␤-blockers produced net harm in surgical patients.The publication of POISE, therefore, should prompt a fairly substantial change in the approach to using ␤-blockers in the patient undergoing noncardiac surgery.After POISE, and until more evidence accumulates, the use of ␤-blockers should be limited primarily to those patients who are on them lifelong or who are on them already.After surgery, the drug should be titrated carefully according to the patient's clinical situation and continued through discharge.