BMJ  2005;331 (6 August), doi:10.1136/bmj.331.7512.0

Perioperative blockers may do more harm than good

Perioperative use of blockers to prevent major cardiovascular events may not be justified in patients having non-cardiac surgery. In a systematic review and meta-analysis of 22 randomised controlled trials that included 2437 patients, Devereaux and colleagues (p 313) found that blockers slightly reduced the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest (relative risk 0.44). However, blockers also more than doubled the risk for bradycardia and increased the risk for hypotension, both conditions that needed treatment. Furthermore, the beneficial results depend on methodologically weak trials.

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How strong is the evidence for the use of perioperative blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials

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BMJ 2005 331: 313-321. [Abstract] [Full Text] [PDF]