BMJ  2005;331:919-920 (22 October), doi:10.1136/bmj.331.7522.919

Editorial

blockers for patients at risk of cardiac events during non-cardiac surgery

Anaesthetists should wait for better evidence of benefit

The first 150 words of the full text of this article appear below.

More than a million patients each year develop cardiovascular complications arising from non-cardiac surgery in the United States alone, and effective strategies and interventions to reduce perioperative cardiac morbidity are badly needed.^{1 2} The best perioperative outcomes for patients at such risk depend partly, as always, on taking a good history, completing a relevant clinical examination, and ordering appropriate investigations.³ But the best strategies for protecting high risk patients from cardiac ischaemia during surgery are still not clear.

One issue—the use of perioperative blockers—is particularly controversial, and a systematic review and meta-analysis by Devereaux et al published recently in the BMJ sheds further doubt on previous evidence.⁴ Unlike many previous studies, which have found that perioperative blockers reduce the risk of major cardiovascular events, this meta-analysis concludes that the evidence is encouraging but too unreliable to allow definitive conclusions to be drawn.⁴

This analysis by Devereaux et al includes 22 . . . [Full text of this article]

(steveb@barwonhealth.org.au)
Division of Perioperative Medicine, Anaesthesia and Pain Management, Geelong Hospital, Geelong, Victoria 3220, Australia

Division of Perioperative Medicine, Anaesthesia and Pain Management, Geelong Hospital, Geelong, Victoria 3220, Australia

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