Perioperative medication management

The management of a patient’s usual medications in the preoperative period is often a difficult and perplexing problem. Among the challenges faced by the physician when managing medication issues for surgical patients are the patient’s response to the stresses of surgery, the patient’s underlying diseases and the degree of control afforded by ongoing treatment, and the likelihood of some period where oral treatment is not an option. In addition, there are few controlled trials regarding perioperative medication discontinuation and resumption, so decisions regarding management are often made based on manufacturer’s recommendations, consensus, or anecdotes. This article will attempt to provide data, when available, for adjusting medications in the perioperative setting and will provide advice when data are lacking. Because some medications are known to influence surgical risk or surgical decisions (eg, antiplatelet agents, anticoagulants, some hormonal therapies, and herbal remedies), it is important to obtain a complete medication list from the patient, including over-the-counter medications and dietary supplements. Adjusting doses or discontinuing certain potentially complicating medications in advance of surgery is one obvious reason that elective procedures are less prone to complications than emergent procedures. Most medications are tolerated well through surgery and do not interfere with anesthetic administration. Therefore, most drugs should be continued through the morning of surgery unless totally unnecessary (eg, vitamins) or contraindicated (eg, herbal products). In particular, antihypertensive, anticonvulsant, and antipsychiatric medications should be given unless specifically contraindicated.