The Beta Blocker
& Clonidine Protocol
(a.k.a. How to avoid death for
Art Wallace, M.D., Ph.D
Associate Professor of Anesthesiology
University of California, San Francisco
Veterans Affairs Medical Center San Francisco
I am Art
Wallace and I have given this lecture many times and decided
it needed to be made more widely available. It has been titled many
things, and although "How to Avoid Death for a Dollar"
was one of my favorites, we finally decided on BBAC: the Beta Blocker
and Clonidine protocol. The reason I am not just calling this the
Beta Blocker protocol is several fold. First, there are other medications
that are not beta blockers that can be used in patients who are
intolerant of beta blockade. Perioperative beta blockade now includes
a second line agent, clonidine, that is useful in patients who have
a contraindication to beta blockers. Moreover, I want to emphasize
that BBAC is intended to do something very different from risk
stratification, which is the classic approach to patients with
cardiac risk coming for surgery. BBAC is
risk reduction therapy. There is still risk, it is just
reduced by BBAC.
Perioperative beta blockade has been in use since
1996 to reduce perioperative morbidity and mortality. Clonidine
was more recently found to have the same effect for patients who
have a contraindication to beta blockers. BBAC has been proven to
significantly lower rates of perioperative mortality.
If the Sitepal animation above
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This course has four goals:
you to recognize when BBAC should be used.
||Teach you how
to implement BBAC as part of a perioperative risk reduction
plan for your hospital
||Track the course's
efficacy in teaching you, and your clinical implementation
of the course's guidelines.
||Help you monitor
your hospital's efficacy in implementing BBAC.
The first two goals require that
you read and study the materials in this course. The third
objective requires that you complete the following form so
that we can track your institute's response to this training
over time. At the end of the course you will be asked to fill
out a short course assessment which will reflect your attitudes
towards the material presented.