Practice Recommendations in the Perioperative Chronic Medication Management in the Surgical Patient
Main Article Content
Abstract
At least 50 percent of patients undergoing surgery take medications on a regular basis. Anesthesiologists in the preoperative assessment of the surgical patient often must decide if chronic medications should be continued in the perioperative period. Unfortunately, there are few outcome data about the majority of medications taken in the perioperative period. The evidenced-based medical literature shows great variability in the attitude taken by different centers regarding the patient`s taking of chronic preoperative medication. This lack of medical evidence is reflected by the large variation in perioperative management recommendations. This topic will focus on medications known to have perioperative effects, those known to interact with anesthetic agents, and those in common use. The present article aims to provide an evidenced-based review of perioperative chronic medication management. Emphasis is placed on the importance of specific recommendations for medication management by different categories of therapeutic agents: cardiovascular, gastrointestinal, pulmonary and endocrine agents. Medications affecting kidney function, psychotropic agents, chronic opioid therapy, rheumatologic and neurologic agents, medications for benign prostatic hypertrophy, herbal medications, and antiretroviral agents have been reviewed.
The management of patients taking glucocorticoids, oral diabetic agents and insulin preoperatively and agents affecting hemostasis is complex and should not be discussed in this paper because probably they should need and specific protocol en each center.
The recommendations in this review are to a large degree expert opinion, based on information from other review and textbooks, along with clinical experience and theoretic considerations.
Article Details
How to Cite
J, García-Miguel F; CASTILLO, Valencia.
Practice Recommendations in the Perioperative Chronic Medication Management in the Surgical Patient.
Medical Research Archives, [S.l.], v. 12, n. 11, nov. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6070>. Date accessed: 12 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i11.6070.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Spell NO 3rd. Stopping and restarting medications in the perioperative period. Med Clin North Am. 2001 Sep;85(5):1117-1128. Doi:10.1016/s0025-7125(05)70367-9.
4. Smith MS, Muir H, Hall R. Perioperative management of drug therapy, clinical considerations. Drugs 1996;Feb;51(2):238-59. Doi:10.2165/00003495-199651020-00005.
5. Clay BJ, Halasyamani L, Stucky ER, Greenwald JL, Williams MV. Results of a medication reconciliation survey from the 2006 Society of Hospital Medicine national meeting. J Hosp Med 2008; 3:465-472. PMID: 19084896 DOI: 10.1002/jhm.370
6. Marcucci M, Painter TW, Conen D, et al. Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery: An International Randomized Controlled Trial. Ann Intern Med.2023 May;176(5):605-614. Doi:10.7326/M22-3157
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