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Internal Medicine


Answer 1
  1. Atenolol. Cardioselective ß1 antagonists (eg, atenolol, metoprolol, bisoprolol) have had a significant impact on the practice of perioperative medicine. These agents recently have been demonstrated to decrease risk of perioperative cardiac complications, such as infarction, arrhythmia, heart failure, and death.1,2 Patients with established coronary artery disease or more than 2 risk factors (eg, diabetes mellitus, hyperlipidemia, hypertension, smoking, age > 65 years) should receive 1 of these agents before surgery for as long as possible, provided there are no contraindications such as asthma, significant bradycardia, high-grade heart block, or overt heart failure.1 While the other agents listed may be useful for perioperative blood pressure control, they should not supplant use of ß-blockers in at-risk patients.

    REFERENCES
    1.
     Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group [published erratum in N Engl J Med 1997;336:1039]. N Engl J Med 1996;335:1713–20.
    2. Poldermans D, Boersma E, Bax JJ, et al. Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery. Eur Heart J 2001;22:1353–8.

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