Difference between revisions of "Preoperative medication management"
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(Created page with "Patients often have a long list of medications they take, and decisions must be made about whether to continue or hold them prior to surgery. == Cardiovascular == === Beta b...") |
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=== Beta blockers === | === Beta blockers === | ||
Continue if taking chronically | ''Continue if taking chronically'' | ||
* Reduces coronary ischemia | * Reduces coronary ischemia | ||
* | * Acute withdrawal of chronic beta blocker associated with increased morbidity/mortality | ||
=== ACE/ARB === | === ACE inhibitors/Angiotensin receptor blockers (ARB) === | ||
Discontinue morning of surgery. However, | ''Discontinue morning of surgery. However, could consider continuing for certain cardiac procedures on patient-by-patient basis'' | ||
* Inhibition of RAAS leads to refractory intraoperative hypotension | * Inhibition of RAAS leads to refractory intraoperative hypotension | ||
* For most surgeries, appears to be no increase in mortality or cardiovascular events from holding ACE/ARB | |||
** However, some studies suggest myocardial protection in CABG | |||
=== Diuretics === | === Diuretics === | ||
''Discontinue morning of surgery if taking for hypertension and euvolemic'' | |||
* | ''Continue if unstable volume status or history of poorly controlled heart failure'' | ||
* Theoretical risk of worsened hypotension due to intravascular depletion, though limited studies showing this in practice | |||
* Theoretical risk of hypokalemia, though this has not been observed in practice | |||
=== Alpha 2 agonists === | === Calcium channel blockers === | ||
Continue if taking chronically | ''Continue'' | ||
* Limited data showing neither benefit nor harm with continuation | |||
=== Alpha 2 agonists (e.g. clonidine) === | |||
''Continue if taking chronically'' | |||
* Prevent rebound hypertension | * Prevent rebound hypertension | ||
=== | === Digoxin === | ||
''Continue'' | |||
* Limited data, though no evidence of adverse effects from continuation | |||
=== Statins === | |||
''Continue'' | |||
* Shown to prevent vascular events perioperatively | |||
== Heme == | == Heme == | ||
=== Anticoagulation === | === Anticoagulation === | ||
=== Antiplatelets === | |||
== Endocrine == | == Endocrine == | ||
Revision as of 01:12, 15 April 2021
Patients often have a long list of medications they take, and decisions must be made about whether to continue or hold them prior to surgery.
Cardiovascular
Beta blockers
Continue if taking chronically
- Reduces coronary ischemia
- Acute withdrawal of chronic beta blocker associated with increased morbidity/mortality
ACE inhibitors/Angiotensin receptor blockers (ARB)
Discontinue morning of surgery. However, could consider continuing for certain cardiac procedures on patient-by-patient basis
- Inhibition of RAAS leads to refractory intraoperative hypotension
- For most surgeries, appears to be no increase in mortality or cardiovascular events from holding ACE/ARB
- However, some studies suggest myocardial protection in CABG
Diuretics
Discontinue morning of surgery if taking for hypertension and euvolemic
Continue if unstable volume status or history of poorly controlled heart failure
- Theoretical risk of worsened hypotension due to intravascular depletion, though limited studies showing this in practice
- Theoretical risk of hypokalemia, though this has not been observed in practice
Calcium channel blockers
Continue
- Limited data showing neither benefit nor harm with continuation
Alpha 2 agonists (e.g. clonidine)
Continue if taking chronically
- Prevent rebound hypertension
Digoxin
Continue
- Limited data, though no evidence of adverse effects from continuation
Statins
Continue
- Shown to prevent vascular events perioperatively