Beta-Blocker Peri-Operative Hold Decisions

Peri-operative beta-blocker decisions are driven by the patient's current hemodynamics and whether the drug is chronic therapy—not by the existence of a surgical booking. Beta-blockers slow heart rate and reduce myocardial contractility, so an appropriate chronic dose may be continued, but giving it when the patient is already bradycardic or hypotensive can worsen perfusion. The nursing task is to obtain reliable heart rate and blood pressure measurements, recognize the pattern, and act within the prescriber's order or institutional protocol. The high-yield distinction is continuation versus initiation. A patient taking a beta-blocker long term is managed differently from a patient being considered for a new beta-blocker just before surgery. Chronic therapy is generally continued; a beta-blocker should not be initiated during the 24 hours before non-cardiac surgery and is generally avoided in the peri-operative period unless clearly indicated by a prescriber.