Chronic medications in the perioperative period

Kurt Kroenke, Dominique Gooby-Toedt, Jeffrey L. Jackson

Research output: Contribution to journalArticle

26 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)358-364
Number of pages7
JournalSouthern Medical Journal
Volume91
Issue number4
DOIs
StatePublished - Apr 1998

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Perioperative Period
Insulin
Aspirin
Steroids
Isophane Insulin
Anesthesiology
Tricyclic Antidepressive Agents
Platelet Aggregation Inhibitors
Warfarin
Operative Time
Oral Contraceptives
Diuretics
Hypoglycemic Agents
Anticoagulants
Atrial Fibrillation
Heparin
Eating
Surveys and Questionnaires

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Chronic medications in the perioperative period. / Kroenke, Kurt; Gooby-Toedt, Dominique; Jackson, Jeffrey L.

In: Southern Medical Journal, Vol. 91, No. 4, 04.1998, p. 358-364.

Research output: Contribution to journalArticle

Kroenke, Kurt ; Gooby-Toedt, Dominique ; Jackson, Jeffrey L. / Chronic medications in the perioperative period. In: Southern Medical Journal. 1998 ; Vol. 91, No. 4. pp. 358-364.
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