Preoperative medication management

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Revision as of 02:17, 15 April 2021 by Tony Wang (talk | contribs) (GI meds)

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

Heme

Anticoagulation

Antiplatelets

Endocrine

Pulmonary

Beta agonists

Gastrointestinal (GI)

H2 blockers/Proton pump inhibitors (PPI)

Continue

  • Very safe intraoperatively
  • Prevents stress ulcers
  • Prevents gastric aspiration/chemical pneumonitis

Psych

Opioids

Other

Herbal supplements

References