Perioperative Strokes and β-Blockade

Abstract

RECENTLY, the results of the PeriOperative Ischemic Evaluation (POISE) study have caused concern regarding β-blocker use in the perioperative setting.1 Though β-blocker therapy was associated with an improved cardiac outcome, overall mortality was increased in the metoprolol-treated group. This was partially related to the increased incidence of postoperative stroke occurring early after surgery. These findings might have important implications on perioperative β-blocker use, not only for initiation of therapy before surgery in β-blocker naïve patients but also whether or not to continue therapy throughout surgery. This commentary reviews the incidence and pathophysiology of perioperative stroke and the relation of β-blockers and perioperative stroke, focusing on noncardiac surgery.