A patient who has been taking beta blockers for CAD and hypertension will be NPO for several days after GI surgery. What IV beta blocker therapy would you recommend?
—L.E. Price, MD, Kissimmee, Fla.

Perioperative beta blockade is generally regarded as helpful in many patients, especially those with known coronary artery disease (N Engl J Med. 2005;353:349-361). In a patient who requires beta blockade but cannot take oral medications, IV preparations are available; some—like esmolol—may be of too short duration for prolonged use since their effects can dissipate quickly. IV metoprolol (5-15 mg boluses) or atenolol (10-20 mg every 12-24 hours) are reasonable choices with careful monitoring of the heart rate to ensure adequate beta blockade.
—Peter F. Cohn, MD (116-21)