Archive for the ‘Beta blockade’ Category

Is preop cards eval dangerous?

Friday, September 17th, 2010

A provocative article from the prolific Toronto group (running neck-and-neck with Rotterdam) that suggests that preop internist/cardiologist consultation before intermediate-high risk surgery leads to more testing. more new beta blockade and statin use, but higher mortality and longer hospital LOS!

Strengths:

  • very large, validated databases
  • sophisticated propensity analysis
  • unmeasured variable that could account for differences would have to be fairly common and have large effects.

Weaknesses:

  • Retrospective study can only show associations, not prove causation
  • The patients that couldn’t matched for propensity analysis were much sicker

From the manuscript’s abstract:

“Conclusions: Medical consultation before major electivenoncardiac surgery is associated with increased mortalityand hospital stay, as well as increases in preoperativepharmacologic interventions and testing. Thesefindings highlight the need to better understand mechanismsby which consultation influences outcomes andto identify efficacious interventions to decrease perioperative risk. ”
Arch Intern Med. 2010;170(15):1365-1374

MY SYLLABUS FOR 2010 AMERICAN SOCIETY OF ANESTHESIOLOGISTS REFRESHER COURSE

Sunday, June 20th, 2010

Ellis ASA Refresher Course Lecture 2010

Click above to download the syllabus

EVERYTHING I KNEW ABOUT BETA BLOCKADE IS WRONG!

Tuesday, June 1st, 2010

Now come 2 (retrospective) articles. One suggests that acute beta blockade is safe in the setting of cocaine-induced chest pain. The other suggests that beta blockers (especially beta1 selective) REDUCE mortality in chronic (not perioperative) patients with COPD. The authors of the latter suggest that this may be due to protection against undiagnosed CAD and/or CHF.