• routine administration of perioperative BB (esp in high doses) is NOT recommended
• however, BB withdrawal is hazardous

• titrate to HR 55 in CAD

• Metoprolol = 5 mg vial

  • 2.5-5 mg IV

• Esmolol = 100 mg vial

  • 0.5-1.0 mg/kg bolus
  • 50-300 mcg/kg/min infusion

• Labetalol = 100 mg / 20 mL = 5 mg/mL

  • 0.25-0.50 mg/kg bolus
  • 2-4 mg/min infusion

(molecular structure)

(formulation)

Mechanism of action

(molecular effects)

(therapeutic effects + indications / side effects + contraindications)

1:CVS

• ⬇myocardial VO2
• redistributes coronary BQ
• perioperative blockade ⮕ ⬇MI, but ⬆stroke, bradycardia, hypotension
  • POISE trial (but doses were large)
• longer term effect
  • ⬇inflammation
  • plaque stabilisation

2:RS

3:NS

• ⬇E activation

4:GIT

5:Renal

6:Endo

7:Reprod

8:Haem

9:MSk

10:Other

• esmolol
  • onset = 1-2 mins
  • offset = 10-30 mins
• metoprolol
  • onset = 1-2 min
  • offset = 5-8 hrs
• labetalol
  • onset = 5-10 min
  • offset = 3-6 hrs

Absorption

• Bioavailability

Distribution

Metabolism

• main organ of metabolism =
• active metabolites =
• et1/2 =

Excretion