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The Beta Blocker and Clonidine Protocol

Lesson 7
Barriers to Implementation

1. Barriers to Implementation of BBAC

Now let's talk about barriers to implementation of BBAC at your hospital. Let's just put the issues right out on the table. You have to recognize the problem before you can fix it. Do you know how many psychiatrists it takes to screw in a light bulb? Well, just one but the light bulb has to want to change. You have to recognize why you are hesitant to use BBAC and then you can overcome those hesitations.

Recommendations for Reducing Risk of PCM

bullet Careful Preoperative H&P
bullet Preoperative Testing Guided by H&P
bullet Prophylactic Perioperative Beta Blockade for Patients with CAD or at risk for CAD. Blockade should start at least 1 week prior to surgery and last for 30 days post surgery
bullet If a patient has a real contra-indication to beta blockade, then use alpha-2 agonist therapy with clonidine

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Content by Art Wallace MD PhD
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