Preoperative drug therapy >> Beta blockade

Beta blocking drugs were not widely prescribed before elective operation.

The anaesthetists caring for the patients in this study were asked whether the patient had received beta blockers before admission. There has been controversy about the possibility that the administration of beta blockers to patients with a history of cardiac disease undergoing major surgery could reduce the incidence of adverse outcomes. Some papers show a benefit whilst others fail to find any effect. Some authorities ¹ have suggested that whenever possible beta blockers should be started days or weeks before surgery in high risk patients. This recommendation is likely to cover most patients undergoing aortic surgery.

Table 1 gives the number of elective patients receiving beta blockers for patients undergoing open procedures.

Table 1. Elective patients receiving beta blockers prior to admission (all open operation patients)
Beta blockers	Total	%
Yes	130	35
No	245	65
Sub-total	375
Unknown	1
Not answered	58
Total	434

Table 2 shows the number of patients admitted as an emergency who were receiving beta blockers prior to admission. Emergency patients are likely to have been receiving beta blockers as part of their regular medication rather than because beta blockers had been prescribed as part of preoperative optimisation.

Table 2. Emergency patients receiving beta blockers prior to admission
Beta blockers	Total	%
Yes	52	26
No	147	74
Sub-total	199
Unknown	21
Not answered	44
Total	264

35% (130/375) of elective patients were receiving beta blockers before admission, compared to 26% (52/199) of emergency admissions.

These data suggest that UK anaesthetists were choosing not to implement the recommendations on the use of preoperative beta blockade cited above at the time of this study. This is consistent with other recent studies showing that only a minority of vascular patients are prescribed beta blocking drugs preoperatively.