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Table 39-4

Pharmacologic Approaches
Administration of β-blockers (may not be effective in lower risk patients or if heart rate is well controlled)
  • Preoperative oral therapy 7–30 d with atenolol or metoprolol
  • Intraoperatively and postoperatively intravenous metoprolol or esmolol titrated to heart rate and blood pressure)

α2-Agonists (clonidine or mivazerol): not investigated as cardioprotective agents in the perioperative environment
Statins: Initiate about 30 d preoperatively and continue 2–4 wk after surgery
ACE inhibitors: Risk is perioperative hypotensive effects
Calcium channel blockers: Not recommended for perioperative cardioprotection
Nitroglycerin: May provoke or exacerbate hypotension with reflex tachycardia; not recommended for perioperative cardioprotection
Anesthetic technique (unproven)
Nonpharmacologic Approaches
Epidural analgesia
Transfusion strategy: May be more important to maintain hemoglobin levels in β-blocked patients
Maintenance of normothermia in the early postoperative period
Endovascular aneurysm repair: Not proven to reduce cardiac risk relative to open repair

ACE = angiotensin-converting enzyme; IV = intravenous.