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EDITORIALS: Stephen Bolsin and Mark Colson blockers for patients at risk of cardiac events during non-cardiac surgery BMJ 2005; 331: 919-920 [Full text]

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Long acting beta blockers’ protection, or short acting beta blockers’ withdrawal?

Atef Michael   (28 October 2005)

Long acting beta blockers’ protection, or short acting beta blockers’ withdrawal? 28 October 2005
Atef Michael, Specialist Registrar City Hospital, Birmingham,UK Send response to journal: Re: Long acting beta blockers’ protection, or short acting beta blockers’ withdrawal?	Editor, Most physicians do not withdraw the beta blockers suddenly especially if the patient has coronary heart disease or was on the drug for long duration; however the editors’ theory of causation to explain the difference between the beta blockers is not strongly convincing. In the study there is no data on when the beta blocker were started, nor the duration of perioperative use of the beta blocker. I am not sure whether there is any strong evidence to support the deleterious effect of sudden withdrawal of beta blockers following very short period of administration, especially in patients with no symptomatic coronary heart disease. The perioperative period represent a cardiovascular stress especially to the elderly patients, many of whom are likely to have limited cardiovascular reserve. It may be that it is the beneficial effect of more prolonged protection of the long acting beta blockers rather than the risk of withdrawal of short acting ones that explain the difference between the two groups. Competing interests: None declared