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Noncardiac Surgery Guidelines Updated — Physician’s First Watch

Medical News |
August 4, 2014

Noncardiac Surgery Guidelines Updated

By Larry Husten

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

The reliability of current guidelines regarding perioperative evaluation and treatment of people undergoing noncardiac surgery has been seriously questioned because of a scandal discrediting Don Poldermans, a widely published Dutch researcher. To address the current uncertainty, U.S. and European medical societies have updated these guidelines.

"Given the recent publication of several large-scale trials, including POISE-II, and new risk calculators, as well as the controversy regarding the use of beta-blockers related to the DECREASE trials, the writing committee felt it was necessary to reevaluate all of the data on cardiovascular care for the patient undergoing noncardiac surgery," said U.S. Writing Committee Chair Lee Fleisher, in a news release.

Regarding beta-blockers, the subject of much of the controversy, the U.S. and European guidelines now don't recommend routine use in patients undergoing noncardiac surgery, though people who are already taking beta-blockers should continue taking them. (Previously the European guideline supported routine use of beta-blockers.) Both guidelines state that beta-blockers may be initiated prior to surgery in carefully selected higher-risk patients.

Both guidelines say that preoperative initiation of statins may be considered in patients undergoing vascular surgery. People already taking statins should continue taking them.

Reader Comments (1)

Lordeline Ramos-Tarampi, MD Physician, Anesthesiology, Retired

I agree with continuing beta blockers during the peri-operative period. I had a ruptured appendix and unfortunately, for some reason or the other, my beta blocker was "forgotten" in the resident's post-operative orders. (In the haste of the emergency,I went to the hospital early the night before and had not taken my beta blocker either.) I went into afib on my first post-op day, and was in the ICU for 5 days out of the 6 hospital days stay.

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