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Perioperative Beta-Blocker De Novo — FRCA Final MCQ

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HardPerioperative MedicinePerioperative Beta-Blocker De NovoFRCA Final

What is the recommended approach to perioperative beta-blocker therapy in a patient NOT currently on beta-blockers who is undergoing high-risk non-cardiac surgery?

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Correct answer: D — Do not start de novo beta-blockers perioperatively

POISE trial (2008) showed that starting de novo beta-blockers perioperatively reduced MI but increased overall mortality and stroke. Current ESC/ACC guidelines recommend AGAINST starting beta-blockers de novo <24h before surgery. Patients already on beta-blockers should CONTINUE. If starting is considered, begin ≥1 week before with gradual titration.

Reference: ESC – 2024 – Perioperative cardiovascular risk; POISE Trial – 2008