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Volume 353:2513-2515 December 8, 2005 Number 23
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Perioperative Beta-Blocker Therapy and Mortality

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by Lindenauer, P. K.
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To the Editor: The large observational study by Lindenauer et al. (July 28 issue)1 seems to confirm that the administration of beta-blockers improves the postoperative outcome of very high-risk patients undergoing major surgery. Owing to the nonrandomized design of the study, the authors cannot exclude the possibility that other cardioprotective strategies — including prolonged monitoring, aggressive pain control and rehabilitation, intensive insulin therapy, and continuation of lipid-lowering agents — could have been used more frequently or adequately for the patients at highest risk.2,3

On the other hand, the potential harmful effects of beta-blockers raise several questions, including why almost 20 . . . [Full Text of this Article]



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