July 6, 2024

Comprehensive Guide to Preoperative Medication Management

Proper medication management before surgery is crucial for ensuring your safety and optimizing your surgical outcome. This guide provides detailed information on how to handle various medications in the preoperative period. Remember, while these guidelines are comprehensive, they are not a substitute for personalized medical advice. Always follow the specific instructions provided by your healthcare team.

Medications to Continue Up to and Including Day of Surgery

  1. Pain Medications:
    GABA Agonists (e.g., Gabapentin, Pregabalin): These medications should be continued up to and including the day of surgery. They are often used to treat neuropathic pain and can help with postoperative pain management. Take your usual dose with a small sip of water on the morning of surgery. Opioids (e.g., Codeine, Morphine, Tramadol): The management of opioid medications can be complex and requires individualized consideration. Continue these medications as prescribed unless otherwise directed by your healthcare provider. It's crucial to discuss your opioid use with your anesthesiologist to ensure proper pain management during and after surgery. Over-the-counter Pain Medications (e.g., Acetaminophen): These can typically be continued up to the day of surgery. They can help with preemptive pain management. However, always confirm with your surgical team before taking any medication on the day of surgery. Skeletal Muscle Relaxants (e.g., Baclofen, Cyclobenzaprine): These medications are usually continued to prevent withdrawal symptoms. Take your usual dose with a small sip of water on the morning of surgery.
  2. Cardiovascular Medications:
    Most heart and blood pressure medications should be continued up to and including the day of surgery. This includes:
  • Alpha-1 Blockers (e.g., Terazosin, Prazosin)
  • Alpha-2 Agonists (e.g., Clonidine, Guanfacine)
  • Antiarrhythmic Agents (e.g., Amiodarone, Digoxin)
  • Beta Blockers (e.g., Atenolol, Metoprolol)
  • Calcium Channel Blockers (e.g., Amlodipine, Diltiazem)
  • Statins (e.g., Atorvastatin, Simvastatin)
  • Nitrates/Vasodilators (e.g., Isosorbide, Nitroglycerin) These medications are crucial for maintaining cardiovascular stability during the perioperative period. Take your usual morning dose with a small sip of water, even if you've been instructed to fast before surgery. If you're on multiple blood pressure medications, your doctor might advise you to hold certain ones (like ACE inhibitors or ARBs) on the day of surgery.
  1. Antiretroviral/Antiviral Agents:
    If you're on antiretroviral therapy for HIV or antiviral medications for other conditions, it's generally recommended to continue these medications without interruption. Stopping these drugs could lead to viral resistance or rebound. Take your usual dose with a small sip of water on the day of surgery.
  2. Endocrine Medications:
    Thyroid Medications (e.g., Levothyroxine): Continue these as usual, including on the morning of surgery. Maintaining proper thyroid hormone levels is important for your overall health and recovery. Glucocorticoids (e.g., Prednisone): If you're on long-term steroid therapy, it's crucial to continue these medications to prevent adrenal insufficiency. Your doctor may even recommend an increased dose around the time of surgery to combat the stress of the procedure. Aromatase Inhibitors (e.g., Anastrozole): These are typically continued through the perioperative period for patients with hormone-receptor-positive breast cancer.
  3. Gastrointestinal Medications:
    Acid-reducing medications such as Proton Pump Inhibitors (e.g., Omeprazole) and H2 Receptor Blockers (e.g., Famotidine) are usually continued. These medications can help reduce the risk of aspiration during surgery. Take your usual dose on the morning of surgery with a small sip of water.
  4. Neurological/Psychiatric Medications:
    Most neurological and psychiatric medications should be continued to maintain mental health stability and prevent withdrawal symptoms. This includes:
  • Anticholinesterase Inhibitors (e.g., Donepezil)
  • Antiepileptic Agents (e.g., Carbamazepine, Levetiracetam)
  • Anti-Parkinson Agents (e.g., Carbidopa/Levodopa)
  • Antianxiety Agents (e.g., Alprazolam, Buspirone)
  • Antipsychotics (e.g., Haloperidol, Olanzapine)
  • Mood Stabilizers (e.g., Lithium, Valproic Acid)
  • Most Antidepressants Abrupt discontinuation of these medications can lead to withdrawal symptoms or worsening of the underlying condition. Take your usual morning dose with a small sip of water on the day of surgery.
  1. Pulmonary Medications:
    Asthma and COPD medications should generally be continued, including on the day of surgery. This includes:
  • Inhaled Anticholinergic Agents (e.g., Ipratropium, Tiotropium)
  • Inhaled Beta-2 Agonists (e.g., Albuterol, Salmeterol)
  • Leukotriene Inhibitors (e.g., Montelukast) These medications help maintain optimal lung function, which is crucial during the perioperative period. Use your inhalers as usual on the morning of surgery.
  1. Urinary Agents:
    Medications for benign prostatic hyperplasia (e.g., Tamsulosin) and overactive bladder (e.g., Oxybutynin) are typically continued. However, if you're having eye surgery, discuss alpha-1 blockers with your surgeon as they can affect pupil dilation.

Medications to Discontinue One Day Prior to Procedure:

  1. Antimigraine Agents ("triptans"): These should be stopped one day before surgery due to their effects on blood vessels. If you experience a migraine, discuss alternative treatments with your doctor.
  2. Non-statin Lipid Lowering Agents: Medications like fenofibrate or ezetimibe are typically stopped the day before surgery. The temporary discontinuation shouldn't significantly affect your cholesterol levels.
  3. Theophylline: This medication for asthma or COPD is usually stopped the day before surgery due to its narrow therapeutic window and potential interactions with anesthesia.

Medications to Discontinue on Day of Procedure:

  1. ACE Inhibitors and ARBs: These blood pressure medications are often held on the morning of surgery as they can interact with anesthesia and cause excessive drops in blood pressure during surgery.
  2. Diuretics: "Water pills" are typically held on the day of surgery to avoid dehydration and electrolyte imbalances.

Medications Requiring Special Considerations:

  1. Diabetes Medications: The management of diabetes medications is crucial and individualized. Insulin regimens often need adjustment, and oral medications are typically held on the day of surgery. SGLT2 inhibitors should be stopped three days before surgery due to the risk of diabetic ketoacidosis.
  2. Blood Thinners and Antiplatelet Medications: The management of these medications depends on your specific risk factors and the type of surgery. Some may need to be stopped several days before surgery, while others might be continued. Always follow your doctor's specific instructions.
  3. Immunosuppressants and Antirheumatic Agents: These medications often require careful consideration. Some may be continued to prevent disease flares, while others might need to be temporarily stopped. Consult with your rheumatologist or transplant physician for personalized advice.
  4. Hormone Therapies: Medications like postmenopausal hormone therapy or tamoxifen might need to be stopped several weeks before surgery due to the increased risk of blood clots. Discuss the risks and benefits with your doctor.
  5. Oral Chemotherapy: The management of these medications is highly individualized. Always consult with your oncologist for specific instructions.
  6. Herbal Supplements and Vitamins: Generally, these should be discontinued 7 days before surgery as they can interact with anesthesia or affect blood clotting. Always inform your surgical team about any supplements you're taking.

Remember, this guide provides general information, but your specific medication management plan may differ based on your individual health status and the type of surgery you're undergoing. Always provide a complete and up-to-date list of all your medications, including over-the-counter drugs and supplements, to your healthcare team. Follow their instructions carefully, and don't hesitate to ask questions if anything is unclear. Proper medication management is a crucial step in ensuring a safe surgery and smooth recovery.​​​​​​​​​​​​​​​​

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