संज्ञानश्वासन और निदान शोध जर्नल
खुला एक्सेस

अमूर्त

Management of Chronic Medication Therapies in the Perioperative Period: a Literature Review

Daniela Almeida, Cristina Pereira, Paula Sá Couto and Humberto S Machado

Introduction: More than half of the patients scheduled for elective surgery are on chronic medication therapies (CMT), which make their management an essential priority for every staff member participating in the perioperative period. This review gathers information on the safest management of patients’ CMT according to the most recent literature.

Methods: A literature review of recent expert recommendations and current evidence on management of CMT in the perioperative period was gathered by a selective search in PubMed, Medline and Embase databases was performed.

Results and discussion: Cardiovascular medication should generally be continued in the preoperative period, with exception of ACEIs (Angiotensin-converting-enzyme inhibitors) and ARBs (angiotensin II receptor antagonists), which increase the risks of severe hypotension under anaesthesia. β-blockers, if acutely withdrawn, may lead to significant morbidity and mortality. Coagulation and antiplatelet medication requires a more multidisciplinary approach, weighting ischemic risks and bleeding risks. Intravenous reversible glycoprotein inhibitors can be used as bridging therapy for patients with very high risk of stent thrombosis. Management of patients treated with New Oral Anticoagulants (NOAC) must consider both kidney function and surgical bleeding risk. Diabetic oral agents should be held prior to surgery, and substituted with insulin supplementation as required. Anti-seizure, antipsychotics and most antidepressants should be continued. Lithium should be discontinued before surgery.

Conclusion: The patient’s comorbidities, clinical status and planned procedure must be considered when managing chronic medication in the perioperative period.