Perioperative β blockade

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5640 (Published 19 September 2013) Cite this as: BMJ 2013;347:f5640
  1. Stephen Bolsin, specialist anaesthetist, Geelong Hospital1,
  2. Mark Colson, specialist anaesthetist, Geelong Hospital1,
  3. Angela Marsiglio, anaesthetic registrar, Geelong Hospital1
  1. 1Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3000, Australia
  1. STEVEB{at}barwonhealth.org.au

For patients undergoing non-cardiac surgery, only those needing heart rate or blood pressure control perioperatively should start β blockers

The implicit requirement of evidence based medicine is that the evidence is not fraudulent. When fraudulent research is published in the medical literature it is given similar weight to bona fide research and can harm patients. Bouri and colleagues recently showed that current European and American guidelines on the use of perioperative β blockers to prevent cardiac events relies on misleading and fraudulent research and may have contributed to 10 000 excess patient deaths.1 If true, this serious allegation must be investigated and guidelines corrected immediately. If it has no basis in fact, the allegation must be retracted.

For many years it had seemed that the evidence supporting the use of perioperative β blockade was based on misleading publications, and it was not until the large POISE trial that the benefits of β blockade at the time of major and intermediate surgery were clearly evaluated.2 3 The problem with the initial study from the MCSPI (Multicentre Study of Perioperative Ischemia) research group was that the …

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