1 3 J Anesth DOI 10.1007/s00540-016-2232-z REVIEW ARTICLE Beta-blockers in vascular surgery patients: is the debate still going on? George Galyfos 1,2 · Konstantinos Filis 1 · Fragiska Sigala 1 · Georgios Geropapas 2 Received: 7 April 2016 / Accepted: 5 August 2016 © Japanese Society of Anesthesiologists 2016 than in the general population, and blood pressure control is considered critical for secondary medical prevention [1]. Therefore, optimal medical therapy for these patients spe- cifically includes controlling hypertension, smoking ces- sation, strict glycemic control, and administration of beta- blockers, antiplatelet agents, and statins [2]. Although beta-blockade remains a cornerstone of opti- mal perioperative management, there has been some debate recently in the literature concerning standardized initiation of such agents for all patients undergoing vascular surgery. Therefore, our aim is to present all recent data on this mat- ter and produce useful conclusions for everyday clinical practice. Perioperative myocardial ischemia and beta-blockade According to its latest universal definition, myocardial infarction (MI) can be generally categorized into types 1 or 2. Type 1 MI is defined as an acute coronary syndrome that occurs when a coronary plaque ruptures, leading to thrombus formation, acute coronary thrombosis, supply ischemia and infarct. These events reduce arterial blood flow, resulting in myocardial damage. Myocardial damage can also be caused by a sustained myocardial oxygen sup- ply–demand imbalance, which leads to type 2 MI. During vascular surgery procedures, high catecholamine produc- tion is responsible for vasoconstriction and haemodynamic stress, associated with an increased oxygen demand from the myocardium. Therefore, perioperative myocardial dam- age may occur when the increase in oxygen demand is not compensated by a corresponding increase in oxygen sup- ply. Moreover, perioperative fluid administration increases the pre- and afterload in the left ventricle, making patients Abstract Patients undergoing vascular surgery are under increased risk for perioperative myocardial ischemia and cardiovascular complications, and optimal medical treat- ment is therefore imperative for these patients. Beta- blockade has been introduced as a cornerstone of optimal management, and standardized preoperative initiation has been recommended in the past. However, recent pooled data have questioned prior recommendations and have led to revision of international guidelines. This review aims to highlight the debate on perioperative beta-blockade for vascular surgery patients in order to produce useful conclu- sions for everyday clinical practice. Keywords Vascular surgery · Beta-blockers · Perioperative management Introduction The prevalence of coronary artery disease (CAD) in patients scheduled for vascular surgery is increasing, and this population especially is under increased risk for acute coronary events, both perioperatively as well as in the early postoperative setting. Furthermore, the prevalence of hypertension among patients with peripheral artery dis- ease or patients scheduled for vascular surgery is higher * George Galyfos georgegalyfos@hotmail.com 1 Vascular Surgery Division, First Propedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, 6 Melinas Merkouri Str., Neon Irakleion, 14122 Athens, Greece 2 Department of Vascular Surgery, KAT General Hospital, Athens, Greece