Peri-operative β-blockade and haemodynamic optimisation in patients with coronary artery disease and decreasing exercise capacity presenting for major noncardiac surgery

Patients with coronary artery disease presenting for major noncardiac surgery may have indications for both peri-operative beta-blockade and haemodynamic optimisation. The combination of peri-operative cardiorespiratory failure and myocardial ischaemia has a grave prognosis. Recent investigations have shown that in patients with coronary artery disease, beta-blockade does not depress cardiac output as much as originally thought. There may, therefore, be a place for both peri-operative beta-blockade and haemodynamic optimisation. The indications for peri-operative beta-blockade and haemodynamic optimisation, the effect of acute beta-blockade on cardiac output in patients with coronary artery disease, and the interaction of peri-operative beta-blockade and haemodynamic optimisation are discussed.