Faculty Collaboration Database

Chronic medications in the perioperative period. South Med J 1998 Apr;91(4):358-64

Date

05/01/1998

Pubmed ID

9563428

DOI

10.1097/00007611-199804000-00009

Scopus ID

2-s2.0-0031947327 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND: While most chronic medications can be safely continued in the perioperative period, decisions regarding certain medications remain controversial.

METHODS: We mailed a questionnaire to all 150 anesthesiology program directors in the United States, with 113 (75%) responding. Opinions regarding preoperative discontinuance or modification of selected medications were assessed.

RESULTS: Antiplatelet agents are typically discontinued preoperatively, although the number of days varies widely. Few respondents discontinue tricyclic antidepressants, oral contraceptives, diuretics, or oral hypoglycemic agents. For a patient on insulin, the most popular regimen is half the patient's usual dose of neutral protamine Hagedorn insulin (50%) or no preoperative insulin (37%), whereas an insulin infusion for tight control was rarely advised. Respondents varied widely in their approach to steroid coverage, their cancellation of elective operations in patients with inadvertent aspirin ingestion, and the length of time before surgery they would discontinue warfarin. In patients with chronic atrial fibrillation, 72% of respondents favored use of a heparin window preoperatively.

CONCLUSIONS: Practice variations regarding insulin regimens, steroid coverage, aspirin, and anticoagulants reflect a lack of firm evidence favoring one approach.

Author List

Kroenke K, Gooby-Toedt D, Jackson JL

Author

Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Anesthesiology
Anticoagulants
Aspirin
Humans
Insulin
Intraoperative Care
Middle Aged
Patient Care Management
Pharmaceutical Preparations
Platelet Aggregation Inhibitors
Practice Patterns, Physicians'
Preoperative Care
Steroids
Surveys and Questionnaires