1. General Guidelines: The 7
It is difficult to make a protocol for all hospitals
because systems work in different ways. However, there are seven
(7) basic rules that should be followed.
Rules 1 - 3:
1. All patients who either have coronary artery
disease (CAD), peripheral vascular disease (PVD), or two risk
factors for coronary artery disease (age > 65, cigarette smoking,
diabetes, hypertension, cholesterol > 240 mg/dl) should be
on perioperative beta blockade unless they have a specific intolerance
to beta blockers. Patients with renal failure or renal insufficiency
may also benefit from therapy.
2. If a patient has an absolute contraindication
to perioperative beta blockers, clonidine may be used as an alternative.
Clonidine should be administered as follows.
3. Beta blockade should be started as soon as the
patient is identified as having CAD, PVD, or risk factors. If
the surgeon identifies the patients as having risk, the surgeon
should start the medication. If the anesthesia preop clinic identifies
the patient, it should be started in the preop clinic. If the
patient is not identified until the morning of surgery, intravenous
atenolol or metoprolol should be used. If the drug is started
prior to the day of surgery, Atenolol 25 mg PO QD is an appropriate