Archives of Neuroscience

Published by: Kowsar

Benefits and Harms of Beta Blockers in the Perioperative Period of Non-Cardiac Surgery: A Narrative Review

Alborz Sherafati 1 and Reza Mollazadeh 2 , *
Authors Information
1 Assistant Professor of Cardiology, Cardiology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Associate Professor of Cardiac Electrophysiology and Pacemaker, Cardiology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Article information
  • Archives of Neuroscience: October 2017, 4 (4); e57718
  • Published Online: October 25, 2017
  • Article Type: Review Article
  • Received: July 7, 2017
  • Accepted: October 4, 2017
  • DOI: 10.5812/archneurosci.57718

To Cite: Sherafati A, Mollazadeh R. Benefits and Harms of Beta Blockers in the Perioperative Period of Non-Cardiac Surgery: A Narrative Review, Arch Neurosci. 2017 ; 4(4):e57718. doi: 10.5812/archneurosci.57718.

Copyright © 2017, Archives of Neuroscience. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Chronic Consumption
3. Time of Initiation
4. Titration and Duration
5. Effect on Myocardial Infarction
6. Effect on Mortality
7. Effect on Stroke
8. Effect on Blood Pressure and Heart Rate
9. Effect on Arrhythmia
10. Type of Beta-Blocker
11. Guideline Recommendations on New Initiation of Beta-Blockers
12. Conclusion
  • 1. Daumerie G, Fleisher LA. Perioperative beta-blocker and statin therapy. Curr Opin Anaesthesiol. 2008; 21(1): 60-5[DOI][PubMed]
  • 2. White CM, Talati R, Phung OJ, Baker WL, Reinhart K, Sedrakyan A, et al. Benefits and risks associated with beta-blocker prophylaxis in noncardiac surgery. Am J Health Syst Pharm. 2010; 67(7): 523-30[DOI][PubMed]
  • 3. Devereaux PJ, Sessler DI. Cardiac Complications in Patients Undergoing Major Noncardiac Surgery. N Engl J Med. 2015; 373(23): 2258-69[DOI][PubMed]
  • 4. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014; 64(22): 77-137[DOI][PubMed]
  • 5. Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014; 35(35): 2383-431[DOI][PubMed]
  • 6. Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol. 2017; 33(1): 17-32[DOI][PubMed]
  • 7. Poise Study Group , Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008; 371(9627): 1839-47[DOI][PubMed]
  • 8. London MJ, Hur K, Schwartz GG, Henderson WG. Association of perioperative beta-blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA. 2013; 309(16): 1704-13[DOI][PubMed]
  • 9. Dunkelgrun M, Boersma E, Schouten O, Koopman-van Gemert AW, van Poorten F, Bax JJ, et al. Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg. 2009; 249(6): 921-6[DOI][PubMed]
  • 10. Wijeysundera DN, Duncan D, Nkonde-Price C, Virani SS, Washam JB, Fleischmann KE, et al. Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130(24): 2246-64[PubMed]
  • 11. Wijeysundera DN, Beattie WS, Wijeysundera HC, Yun L, Austin PC, Ko DT. Duration of preoperative beta-blockade and outcomes after major elective noncardiac surgery. Can J Cardiol. 2014; 30(2): 217-23[DOI][PubMed]
  • 12. Brady AR, Gibbs JS, Greenhalgh RM, Powell JT, Sydes MR, Pobble trial investigators . Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial. J Vasc Surg. 2005; 41(4): 602-9[DOI][PubMed]
  • 13. Juul AB, Wetterslev J, Gluud C, Kofoed-Enevoldsen A, Jensen G, Callesen T, et al. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ. 2006; 332(7556): 1482[DOI][PubMed]
  • 14. Yang H, Raymer K, Butler R, Parlow J, Roberts R. The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J. 2006; 152(5): 983-90[DOI][PubMed]
  • 15. Zaugg M, Bestmann L, Wacker J, Lucchinetti E, Boltres A, Schulz C, et al. Adrenergic receptor genotype but not perioperative bisoprolol therapy may determine cardiovascular outcome in at-risk patients undergoing surgery with spinal block: the Swiss Beta Blocker in Spinal Anesthesia (BBSA) study: a double-blinded, placebo-controlled, multicenter trial with 1-year follow-up. Anesthesiology. 2007; 107(1): 33-44[DOI][PubMed]
  • 16. Kaafarani HM, Atluri PV, Thornby J, Itani KM. Beta-Blockade in noncardiac surgery: outcome at all levels of cardiac risk. Arch Surg. 2008; 143(10): 940-4
  • 17. Rajeev S, Wong DT. Effect of beta-blockers on perioperative myocardial ischemia in patients undergoing noncardiac surgery. Curr Drug Targets. 2009; 10(9): 833-41[PubMed]
  • 18. Talati R, Reinhart KM, White CM, Phung OJ, Sedrakyan A, Kluger J, et al. Outcomes of perioperative beta-blockade in patients undergoing noncardiac surgery: a meta-analysis. Ann Pharmacother. 2009; 43(7): 1181-8[DOI][PubMed]
  • 19. Bouri S, Shun-Shin MJ, Cole GD, Mayet J, Francis DP. Meta-analysis of secure randomised controlled trials of beta-blockade to prevent perioperative death in non-cardiac surgery. Heart. 2014; 100(6): 456-64[DOI][PubMed]
  • 20. Andersson C, Merie C, Jorgensen M, Gislason GH, Torp-Pedersen C, Overgaard C, et al. Association of beta-blocker therapy with risks of adverse cardiovascular events and deaths in patients with ischemic heart disease undergoing noncardiac surgery: a Danish nationwide cohort study. JAMA Intern Med. 2014; 174(3): 336-44[DOI][PubMed]
  • 21. Blessberger H, Kammler J, Steinwender C. Perioperative use of beta-blockers in cardiac and noncardiac surgery. JAMA. 2015; 313(20): 2070-1[DOI][PubMed]
  • 22. Jorgensen ME, Hlatky MA, Kober L, Sanders RD, Torp-Pedersen C, Gislason GH, et al. beta-Blocker-Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery. JAMA Intern Med. 2015; 175(12): 1923-31[DOI][PubMed]
  • 23. Friedell ML, Van Way C3, Freyberg RW, Almenoff PL. beta-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful? JAMA Surg. 2015; 150(7): 658-63[DOI][PubMed]
  • 24. van Lier F, Schouten O, van Domburg RT, van der Geest PJ, Boersma E, Fleisher LA, et al. Effect of chronic beta-blocker use on stroke after noncardiac surgery. Am J Cardiol. 2009; 104(3): 429-33[DOI][PubMed]
  • 25. van Lier F, Schouten O, Hoeks SE, van de Ven L, Stolker RJ, Bax JJ, et al. Impact of prophylactic beta-blocker therapy to prevent stroke after noncardiac surgery. Am J Cardiol. 2010; 105(1): 43-7[DOI][PubMed]
  • 26. Patorno E, Wang SV, Schneeweiss S, Liu J, Bateman BT. Patterns of beta-blocker initiation in patients undergoing intermediate to high-risk noncardiac surgery. Am Heart J. 2015; 170(4): 812-820 e6[DOI][PubMed]
  • 27. Cohn SL. Preoperative Evaluation for Noncardiac Surgery. Ann Intern Med. 2016; 165(11)-96[DOI][PubMed]
  • 28. Ashes C, Judelman S, Wijeysundera DN, Tait G, Mazer CD, Hare GM, et al. Selective beta1-antagonism with bisoprolol is associated with fewer postoperative strokes than atenolol or metoprolol: a single-center cohort study of 44,092 consecutive patients. Anesthesiology. 2013; 119(4): 777-87[DOI][PubMed]
  • 29. Zangrillo A, Turi S, Crescenzi G, Oriani A, Distaso F, Monaco F, et al. Esmolol reduces perioperative ischemia in cardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth. 2009; 23(5): 625-32[DOI][PubMed]
  • 30. Yu SK, Tait G, Karkouti K, Wijeysundera D, McCluskey S, Beattie WS. The safety of perioperative esmolol: a systematic review and meta-analysis of randomized controlled trials. Anesth Analg. 2011; 112(2): 267-81[DOI][PubMed]
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .
Readers' Comments