Perioperative Management

This summary is derived from:


Nowbar AN et al. International RCT-based guidelines for use fo pre-operative stress testing and peri-operative beta-blockers and statins in non-cardiac surgery. Int J Cardiol (2014),


1. Statins


There are no data to guide management in this context


Offer to patients whose risk status merits it (See NICE - current draft recommendations suggest patients with a 10% risk or greater of developing CVD over 10 years using QRISK2 should be considered)

Patients who have existing CVD should already be taking a statin


2. Stress Testing to Detect Ischaemia


There are no data to guide management

A balance has to be struck between the risk of allowing surgery to continue without investigation and managment of angina, and the risks of delay if investigations are undertaken


3. Beta-blockers


Beta-blockers should not be routinely initiated perioperatively

The trial data that does exist suggests an increase in mortality


What I love about this paper is that it is devoid of opinion and simply shows how little we know.