UCSF - University of California, San Francisco
US Dept of Veteran Affairs, San Francisco
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The Beta Blocker and Clonidine Protocol

Lesson 4
Lesson 4 - Beta Blockers

5. Atenolol Study: Surgeries

What kind of surgery? Normal stuff that normal hospitals do. Things like major vascular, intra-abdominal, orthopedic, neurosurgical, intra-thoracic, head and neck, plastics. What about gynecology? The VA doesn't have many female patients, so the study doesn't have women. We are sorry. We would like to include women, there just aren't many at the VA. That being said, women get heart disease, women have heart attacks, women have higher risks than men with CABG. Does BBAC apply to women? YES! I just don't have evidence for its benefits in women. Does this mean I can ignore patients who have minor surgery? No! Five to twenty percent (5-20%) of patients who have cardiac risk have an episode of myocardial ischemia the night before surgery. They have it because they are stressed thinking about surgery. Surgery leads to stress, stress leads to myocardial ischemia, myocardial ischemia leads to myocardial infarction, myocardial infarction leads to death. Patients scheduled for minor surgery can still get into this cycle. How many patients have you seen scheduled for a cataract with intraoperative lens implant (IOL), a really minor procedure, who come in with a blood pressure of 220/110 mmHg. These people are stressed just thinking about surgery. We study bigger operations because the sample sizes for statistical significance are smaller. Patients scheduled for minor cases deserve good anesthesia too, and that means BBAC for them as well.

Surgery Included:

bullet Major Vascular
bullet Intra-abdominal
bullet Neurosurgical
bullet Intra-thoracic
bullet Head and Neck
bullet Plastics


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Content by Art Wallace MD PhD
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