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.