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Perioperative Beta Blockade Guidelines

History. Mangano showed that IV atenolol prior surgery and postoperatively until discharge reduced postoperative mortality significantly out to 2 years.. History. Poldermans showed that perioperative bisoprolol reduced postoperative myocardial events significantly.. History. Dr. David Brown, Profess

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Perioperative Beta Blockade Guidelines

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    1. 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.

    5. Where can I find the Guidelines? http://policies.uihc.uiowa.edu/Governing%20Body%20Directives/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

    6. 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.

    7. 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

    8. Who is eligible for PBB? Any 2 of the following: Age > 50 Hypertension Current smoking Diabetes Hyperlipidemia

    9. Preoperatively Atenolol 25 mg every morning PO Start 7 days preoperatively preferably Goal is to get heart rate < 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

    10. Intraoperatively Metoprolol IV push as necessary Goal is HR < 60 or SBP < 110

    11. Postoperatively in monitored units Metoprolol 2-5 mg IV push for HR > 60 or SBP > 110 May repeat every 10 minutes Not to exceed _____ doses Order most likely written by Anesthesia in PACU

    12. Postoperatively in non-monitored units Metoprolol (not to exceed 10mg) in 50 ml NS infused over 30 minutes for HR > 70 and SBP > 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

    13. 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

    14. Questions? Page the anesthesia chief resident on beeper 3911 for guideline questions.

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