West Los Angeles Veterans Administration Healthcare Center - Orthopaedic Surgery

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BBAC: The Beta Blocker & Clonidine Protocol

originally by Art Wallace MD PhD copied from

History and Physical Exam: with attention to coronary artery disease, peripheral vascular disease, age, hypertension, diabetes, smoking, and hyperlipidemia.

Patient Scheduled for Surgery with:

IF Coronary Artery Disease ------->

IF Peripheral Vascular Disease------->

IF Two Risk Factors: ------->

bullet Age > 65
bullet Hypertension
bullet Diabetes
bullet Cholesterol > 240 mg/dl
bullet Smoking

Beta Blockers:

* Atenolol 25 mg PO q.d. to start, if heart rate greater than 60 and systolic blood pressure greater than 120 mmHg. Titrate dose to effect.
* Atenolol or Metoprolol IV on day of surgery.
* Atenolol or Metoprolol IV post op until taking PO then.
* Atenolol 100 mg PO q.d. for at least a week post op (hold for heart rate less than 55 or systolic blood pressure less than 100 mmHg)
* If known CAD or PVD continue beta blocker indefinitely.


bullet Aortic Stenosis
bullet Congestive Heart Failure
bullet Unstable Angina
bullet New Onset Angina
bullet Change in Anginal Pattern
bullet Angina without Medical Therapy
bullet Recent PCI with Intracoronary Stent on Platelet Inhibitor


Refer to Cardiology

If Unable to take beta blockers


If patient has a specific contraindication (asthma not COPD) to beta blockers:

* Clonidine 0.2 mg PO tablet night before surgery
* Clonidine TTS#2 Patch (0.2 mg/24 hours) night before surgery
* Clonidine 0.2 mg PO table morning of surgery.
* Hold for systolic blood pressure less than 120.


Proceed with Surgery




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This is a web summary of guidelines for the West L.A. VA Healthcare Center orthopaedic surgery resident physicians. It is intended to make your life easier by gathering information that may be useful into one location.
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Last updated: July 17, 2007.