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CARDIOVASCULAR ANESTHESIA

Knowledge and Practice Regarding Prophylactic Perioperative Beta Blockade in Patients Undergoing Noncardiac Surgery: A Survey of Canadian Anesthesiologists

Department of Anesthesiology, Queen’s University, Kingston General Hospital, Ontario, Canada

Address correspondence and reprint requests to Elizabeth G. VanDenKerkhof, RN, Department of Anesthesiology, Queen’s University, Kingston General Hospital, 76 Stuart St., Kingston, ON K7L 2V7. Address e-mail to ev5{at}post.queensu.ca

A lack of awareness of the "best" current practice is frequently cited as a major barrier to the practice of evidence-based medicine. The purpose of this study was to survey Canadian anesthesiologists to determine their knowledge and practices associated with prophylactic perioperative ß blockade, a therapy that has been widely discussed in the literature and has the potential for a significant positive impact on patient outcomes. We sent questionnaires to 1234 members of the Canadian Anesthesiologists’ Society. The overall response rate was 54%. Ninety-five percent of respondents were aware of the perioperative ß blocker literature, and of these, 93% agreed that ß blockers were beneficial in patients with known coronary artery disease (CAD). Fifty-seven percent reported always or usually administering prophylactic ß blockers in patients with known CAD, and 34% of these regular users continued therapy beyond the early postoperative period. Only 9% of respondents reported that a formal protocol existed at their facility. This study suggests that barriers to the translation of research to practice were not related to a lack of awareness of the current best evidence. With respect to perioperative ß blockers, controversies within the literature as well as practical considerations may be greater barriers to implementation of best evidence.

IMPLICATIONS: This survey found that anesthesiologists were aware of and supported the use of prophylactic perioperative ß blockers in patients with risk factors or known coronary artery disease; however, only 57% frequently prescribed perioperative ß blockers. A lack of awareness of the current "best" evidence was not a barrier to use.

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