The experts debate: perioperative beta-blockade for noncardiac surgery--proven safe or not?

Cleve Clin J Med. 2009 Nov:76 Suppl 4:S84-92. doi: 10.3949/ccjm.76.s4.14.


Guidelines on perioperative management of patients undergoing noncardiac surgery recommend the use of prophylactic perioperative beta-blockers in high-risk patients who are not already taking them, and their continuance in patients on chronic beta-blockade prior to surgery. These recommendations were challenged recently by results of the Perioperative Ischemic Evaluation (POISE), a large randomized trial of extended-release metoprolol succinate started immediately before noncardiac surgery in patients at high risk for atherosclerotic disease. While metoprolol significantly reduced myocardial infarctions relative to placebo in POISE, it also was associated with significant excesses of both stroke and mortality. The merits and limitations of POISE and its applicability in light of other trials of perioperative beta-blockade are debated here by two experts in the field-Dr. Don Poldermans and Dr. P. J. Devereaux (co-principal investigator of POISE).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / adverse effects
  • Adrenergic beta-Antagonists / therapeutic use*
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / therapeutic use
  • Humans
  • Hypotension
  • Metoprolol / administration & dosage
  • Metoprolol / therapeutic use
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / prevention & control*
  • Perioperative Care / methods*
  • Risk Assessment
  • Surgical Procedures, Operative / methods*
  • Time Factors


  • Adrenergic beta-Antagonists
  • Antihypertensive Agents
  • Metoprolol