7b. Implementing a Beta Blocker Protocol

Cardiac Risk Reduction Therapy (Beta Blockers & Clonidine/BBAC) 2.0

Patient Scheduled for Surgery with:

IF Coronary Artery Disease ------->

IF Peripheral Vascular Disease------->

IF Two Risk Factors: ------->

  • Age > 65
  • Hypertension
  • Diabetes
  • Cholesterol > 240 mg/dl
  • Smoking

Beta Blockers:

* Atenolol 25 mg po qd to start, if heart rate greater than 60 and systolic blood pressure greater than 120 mmHg. Titrate dose to effect.
* Atenolol or Metoprolol IV on day of surgery.
* Atenolol or Metoprolol IV post op until taking PO then.
* Atenolol 100 mg PO qd for at least a week post op (hold for heart rate less than 55 or systolic blood pressure less than 100 mmHg)
* If known CAD or PVD continue beta blocker indefinitely.


  • Aortic Stenosis
  • Congestive Heart Failure
  • Unstable Angina
  • New Onset Angina
  • Change in Anginal Pattern
  • Angina without Medical Therapy
  • Recent PCI with Intracoronary Stent on Platelet Inhibitor


Refer to Cardiology

If Unable to take beta blockers


If patient has a specific contraindication (asthma not COPD) to beta blockers:

* Clonidine 0.2 mg PO tablet night before surgery
* Clonidine TTS#2 Patch (0.2 mg/24 hours) night before surgery
* Clonidine 0.2 mg PO table morning of surgery.
* Hold for systolic blood pressure less than 120.


Proceed with Surgery

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