12. Patient Profiles:
Intraoperative Hemodynamic Medications
Maybe the anesthesiologists in the study, identified
some catastrophic problem in the patients treated with beta blockers
and gave a medication to rescue them. Is that why there is no
difference in blood pressure? NO. There is no difference in the
medications used to control blood pressure between the two groups.
NONE.
Let me ask a question. What fraction of sick, old
people (VA patient A and B) who you put to sleep drop their blood
pressure? Well, I must admit all of them. Ok, If all sick, old
patients who you put to sleep drop their blood pressure after
induction, what fraction of patients who you administer preoperative
beta blockers to will drop their blood pressure? Well, if it was
100% without the beta blockers, it would probably be at least
100% after the beta blockers. That is correct. Not only is it
exactly the same with and without beta blockers. If I secretly
give them to patients (prospective, randomized, blinded, clinical
trial, and I measure the blood pressure with a computer) I still
can't see either a difference in blood pressure or therapy for
blood pressure related issues. Perioperative beta blockers do
not change the systolic or diastolic blood pressure in an noticeable
or adverse manner with induction or maintenance, or emergence
of anesthesia. You must conquer your fear of beta blockers. Fear
is the enemy. Do not be afraid, give the drug.
