Preoperative medication management
From WikiAnesthesia
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