Is anyone else seeing a trend in all patients with HTN receiving a betablocker during surgery or in PACU whether indicated or not? I've been giving a lot of labetalol and lopressor lately. I believe it is on the way to becoming a new core measure (as if there aren't enough already).
Dec 30, '06
PACU RN, we recover fresh post op cardiac surgeries and generally I've seen betablockers given after the first 12 hours or so post op rather than immediately post op. We use the standard nipride/NTG to titrate for goal Map and the fresh hearts are usually on epi for the first 12-24 hours too. I've seen milrinone used when there are pul HTN issues.
What kind of surgeries are you seeing that require the betablockers immediately post op and are you pleased generally with the results?
Dec 31, '06
Thanks for the reply. It's not any specific cases. The patients who have HTN and take a prescribed betablocker (usually Torpol XL) at home are receiving either lopressor or labetalol by the CRNA during the case (even when the pre-op, intra-op, and immediate post-op BP/HR is fine). It may be related to the patient having been NPO. However, some of our surgeons request the patients to take their meds with a sip of water pre-op so that the betablocker will be on board. I've heard a few of the CRNA's saying that it will be a new core measure soon, similar to what we've been doing with pre-op antibiotics.
Does your facility have anything like this regarding betablockers?
I don't know about the open hearts, they all bypass PACU where I work and go to the CVSU.
Have a great new year!
Jan 1, '07
This does not address your topic, but I started on atenolol yrs ago when my HTN first dx by family doc. Reacted weird at first. For almost 4 days could not get out of bed at all. Did not even pee. Told doc, who didn't understand, she just told me to half the dose from 50 mg to 25 mg. Evenually I got used to that but have been extremely fatigued ever since (although other reasons). Now I have new doc who I asked to change my HTN med after long time off betablocker. She started me on ACE inhibitor and I just added inderal LA which is managing my BP quite nicely. I asked for the inderal d/t seeing 60 minutes piece recently which stated new studies using inderal for post traumatic stress disorder. I figured since I have HTN anyway, why not try it. Must say, I am doing lot better. Anxiety is being helped along with acceptable BP. (But she also put me on klonopin). But I should have had something like this a long time ago. However, still need to see cardio as far as I am concerned d/t previous episodes. Am not certain that BP is my only cardiac problem. Just wanted to talk to you b/c getting on Cardiovasc meds was scary, new; and when I tell docs (not cardiac spec) about my weird reactions they kind of dismiss my comments. Sorry to take up your time with my everyday experiences.
Jan 1, '07
I had gone to an ASPAN seminar where the use of beta blockers was talked about as the latest measure that we would see it more. It has been being used for many surgery patients to prevent heart attacks during or after the operation.
Jan 1, '07
Our anesthesiologists are developing a new Beta blocker protocol that we will have in place in the near future. It involves preop administration (PO) of drugs for patients that meet the criteria (patient history, vascular case, etc).
Jan 1, '07
Thanks for the input everyone. I may post some new threads about some of the latest things we've been doing in PACU where I work.