Anesthesiology
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Biography Historical Article
Life at the frontier: the third annual John W. Severinghaus lecture on translational science.
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Comparative Study
Perioperative β-blockade: atenolol is associated with reduced mortality when compared to metoprolol.
The Atenolol study of 1996 provided evidence that perioperative β-blockade reduced postsurgical mortality. In 1998, the indications for perioperative β-blockade were codified as the Perioperative Cardiac Risk Reduction protocol and implemented at the San Francisco Veterans Affairs Medical Center. The current study tested the following hypothesis: Is there a difference in mortality rates between patients receiving perioperative atenolol and metoprolol? ⋯ Perioperative β-blockade using atenolol is associated with reduced mortality compared with metoprolol.
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Comparative Study
Chronic β blockade is associated with a better outcome after elective noncardiac surgery than acute β blockade: a single-center propensity-matched cohort study.
Current guidelines on perioperative care recommend the prophylactic use of β blockers in high-risk patients undergoing noncardiac surgery. However, recent studies show that, in some instances, perioperative β blockade can cause harm. Furthermore, chronic β blockade, titrated to effect before surgery, may be superior to acute perioperative β blockade. The primary objective of this study was to compare major acute cardiac outcomes in patients who underwent surgery with chronic β blocker therapy with those in patients with acute β-blocker therapy. ⋯ Acute β blockade, initiated within the first 2 days after surgery, was associated with worse cardiac outcome compared with a matched cohort of patients who underwent surgery on chronic β blockade. These results should be validated in a larger prospective trial.