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.
