Expert: Ronald Levy, M.D. - 5/18/2009

Question
QUESTION: Hello - you've answered my questions before and I have another if you dont mind.  I am having laproscopic gall bladder surgery on Wednesday.  I am diabetic and have high cholesterol.  I have no symptoms of heart disease in that I don't have shortness of breath on exertion, have no chest pains, etc. except on occassion elevated blood pressure and heart rate due to anxiety issues.  My internist today told me that I should take 50 Mg Toprol before surgery.  Of course I looked this method up on line and found numerous writings about how taking a beta blocker prior to surgery and for a few days afterwards could cause heart attack or stroke in some.  So my question is, what do you think about taking a beta blocker prior to and after surgery and is this done routinely these days?  How dangerous is it to have surgery when your numbers fluctuate and you have risk factors for heart disease without having symptoms?  I have become quite nervous and I'm tempted to cancel my surgery.  Anything you could add to this would be very important.

ANSWER: Don't believe everything you read on the internet. Generally speaking, we have our patients take their BP meds the night before surgery (including beta blockers). If you want to be sure, ask your anesthesiologist. Make sure to take it with a sip of water. As for your other questions, we take care of people like you every day and the risks of complications is very low. Certainly less than not having the surgery and developing cholecysititis, pancreatitis or ascending cholangitis!

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Thanks for answering so quickly.  I am not seeing the anesthesiologist until 1 hour before surgery - that's why I am concerned.  This is one of the types of articles I've found.http://www.boston.com/news/health/blog/2008/10/beta_hold_til_4.html  What do you say about this?
My question concerns the fact that I don't take beta blockers on a daily basis so taking 50 mg of Toprol before surgery could bring my bp very low as I've no experience with this medication.  So should I take it before I get to hospital or wait to talk to anesthesiologist an hour before.
Again thanks so much,

Answer
Without knowing your medical history it would be hard to say. The worst case is you don't take anything and the anesthesiologist gives ot to you IV before surgery if they feel you need it.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston