Which cardiovascular pharmacologic agents are safe to use during routine abdominal surgery in a 75-year-old woman with documented hypertension and mild coronary artery disease?

A. Nifedipine.

B. Atenolol.

D. Captopril.

DISCUSSION: Nifedipine is tolerated fairly well by elderly patients and is safe to use in the perioperative period with close hemodynamic monitoring. Atenolol is a safe beta-blocker to use during the perioperative period and provides protection from cardiac rhythm disturbances and rebound hypertension. Hydralazine, if given without a beta-blocker, often elicits reflex tachycardia, which limits its usefulness. Captopril is a safe agent that does not appear to interfere with the normal cardiovascular response to anesthesia, and abrupt withdrawal of this agent may result in severe hypertension and should be avoided. Reserpine is an adrenergic inhibitor that may depress cardiac output and result in hypotension, so its use in the perioperative setting is limited.