DOI: 10.1213/00000539-199909000-00056
,
Issn Print: 0003-2999
Publication Date: 1999/09/01
Heart Rate Control and Ischemia
Excerpt
Zaugg and Lucchinetti raise some important points about our recent article. We used Holter monitoring to determine preoperative cardiac risk and to establish the minimal heart rate at which ischemia occurred. However, we do feel that perioperative Holter monitoring needs to be a required procedure for placing patients on prophylactic β-blockers. As we suggest, most patients had ischemic thresholds at heart rates of ≥90 bpm. Therefore, one approach could be to use prophylactic β-blockade to maintain the heart rate at ≤90 bpm for the high-risk 48-h period after vascular surgery. This type of approach would obviate the need for perioperative Holter monitoring or other cardiac testing. It would also include the one third of patients who may not be amenable to Holter electrocardiogram screening due to electrocardiogram alterations. Many medical centers do not require strict heart rate monitoring, as accomplished in our study, for the purpose of administering IV β-blockade. This can often be accomplished with frequent vital signs in a nontelemetered setting, particularly if patients are judged not to be high-risk. In this way, we believe that prophylactic β-blockade can serve as the most cost-efficient method for reducing the risk among high-risk vascular surgery patients.
We also agree with Zaugg and Lucchinetti that β-adrenergic blockade is by no means the only mechanism by which risk of vascular surgery can be reduced, but it is certainly an important one.
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