a. The surgeon starts the patient on a beta blocker if they
have CAD, PVD, or two risk factors. Atenolol 25 mg PO QD is
an appropriate starting dose.
b. If a medical or cardiology consult is requested by surgery,
the most common advice is start a beta blocker.
c. The anesthesia preop clinic checks to see if the patients
at risk are on a beta blocker. If the patient is not adequately
blocked the dose is increased.
d. On the day of surgery the anesthesia providers may increase
the dose or treat with intravenous beta blockers. Intravenous
metoprolol in 5 mg boluses is used. Standard dose is 10 mg IV
(hold for heart rate less than 50 or systolic blood pressure
less than 100 mmHg). Intraoperative doses are used as needed.
The patient is also re-dosed in the PACU post op as needed.
e. The patient remains on the drug post-operatively for 30
days. If the patient is NPO, the patient receives intravenous
metoprolol (10 mg IV Q12). Hold for systolic blood pressure
less than 100 mmHg and/or heart rate less than 50 beats per
minute. If the patient is taking PO medications, the patient
receives atenolol 100 mg PO QD if the heart rate is greater
than 65 and the systolic blood pressure is greater than 100
mmHg. If the heart rate is between 55 and 65 the dose is 50
mg. There is a hold order for heart rate less than 50 or systolic
blood pressure less than 100 mmHg.
f. The patient remains on the drug for at least 30 days postoperatively.
g. Many patients should remain on the drug for life (known
CAD, known PVD, hypertension).
