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Perioperative beta-blocker management — MCCQE Part 1 MCQ

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HardPre-op AssessmentPerioperative beta-blocker managementMCCQE Part 1

A 72-year-old man on chronic metoprolol for coronary artery disease is scheduled for urgent hip fracture repair. Heart rate is 68/min and blood pressure is stable. Which of the following is the most appropriate perioperative medication plan?

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Correct answer: D — Continue his chronic beta-blocker through the perioperative period if haemodynamically stable

Chronic beta-blockers are usually continued perioperatively if the patient is stable to avoid rebound tachycardia and ischaemia. Initiating high-dose beta-blockade immediately before surgery can cause harm. Urgent hip fracture repair should not be delayed unnecessarily for testing unless there are active unstable cardiac conditions.

Reference: Canadian Cardiovascular Society perioperative cardiac risk guideline