Safety of perioperative beta-blocker use: how do beta-blockers compare in terms of side effects?

Introduction: In the perioperative setting, there is still a high incidence of adverse cardiac events due to sudden coronary plaque rupture or oxygen supply-demand imbalance. beta-Blockers play an important role in preventing these cardiac events. Discussion, however, remains on the side effects accompanying this therapy. Areas covered: The evidence for perioperative use of beta-blockers is summarized in this review in terms of risk reduction, perioperative safety and current clinical use. Furthermore, data on pharmacokinetics, pharmacodynamics and pharmacogenetics are presented. Expert opinion: In perioperative care, beta-blockers are recommended and can be given safely when started early in a low dose, titrated to heart rate. In the future, there could be a place for added perioperative short-acting beta-blockers to further optimize heart rate control.