Perioperative beta-blockade, discontinuation, and complications: do you really know it when you see it?

摘要

Attempting to articulate his thoughts on the legal definition of obscenity in the 1960s, Supreme Court Justice Potter Stewart, opined "I know it when I see it." This approach, celebrated at that time as intuitive and pragmatic, was one he later recanted. Clinicians take a similar approach to situations that are often more complex than they appear. In this issue of Anesthesiology, van Klei et al, report an analysis of patterns of perioperative beta-blocker prescription in patients undergoing orthopedic surgery. They conclude that their results provide confirmatory evidence to one of the two class 1 recommendations for "perioperative beta-blockade" of the American College of Cardiology/American Heart Association Perioperative Evaluation Guidelines Committee, paraphrased by the authors as "not to withdraw beta-blocker therapy." As the current guideline comprise only a single paragraph with three literature citations, a closer look at this issue appears timely.