β-blockers

β-blockers are a mainstay of the perioperative management of sinus tachycardia, other tachyarrhythmias, hypertension, myocardial infarction, and heart failure. They can be distinguished by their adrenergic receptor selectivity and intrinsic sympathomimetic activity.

1. According to the 2014 American College of Cardiology and American Heart Association guidelines on the management of patients undergoing noncardiac surgery, patients should continue chronic β-blocker perioperatively as abrupt β-blocker cessation may be associated with increased adverse cardiac events. Preoperative initiation of β-blocker therapy may also be considered in patients with three or more revised cardiac risk index risk factors, which include prior stroke (or transient ischemic attack), diabetes mellitus requiring insulin, serum creatinine ≥2 mg/dL, congestive heart failure, coronary artery disease, and high-risk surgery (thoracic, abdominal, or suprainguinal vascular surgery). Both of these guidelines are supported by level B evidence.
2. β-blockers are contraindicated in patients with severe decompensated heart failure, symptomatic bradycardia in the absence of a pacemaker, and in patients with Wolff-Parkinson-White (WPW) syndrome in atrial fibrillation.