Preoperative medication management - Revision history

Cdseger: Increased details on GLP-1 agonists

2023-08-19T18:34:50Z

Increased details on GLP-1 agonists

← Older revision		Revision as of 11:34, 19 August 2023
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	* Increased risk of lactic acidosis		* Increased risk of lactic acidosis

	=== GLP-1 agonists (e.g. ~~dulaglutide~~) ===		=== GLP-1 agonists (e.g. Ozempic (semaglutide)) ===
	''~~Continue~~''		''Regimen dependent (see below)''

	* No risk for hypoglycemia, ~~though increased risk~~ of ~~gastric~~ motility ~~changes with continuation~~		* No risk for hypoglycemia, however this class has profound impacts on gastric motility. This is especially true for those who recently initiated therapy.
			*June 2023 ASA guidelines by regimen<ref>{{Cite web\|title=Patients Taking Popular Medications for Diabetes and Weight Loss Should Stop Before Elective Surgery, ASA Suggests\|url=https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/patients-taking-popular-medications-for-diabetes-and-weight-loss-should-stop-before-elective-surgery\|access-date=2023-08-19\|website=www.asahq.org}}</ref>:
			**Dosed weekly: hold for one week prior to surgery.
			**Dosed daily: hold for one day prior to surgery.
			*Treat as full-stomach if unable to hold medication, in urgent/emergent situations, or if patient has GI symptoms suggestive of reflux or impaired motility.
			*If taken weekly: Hold for one week.
			*If taken daily: Hold dose on the day of surgery.

	=== SGLT2 inhibitors ===		=== SGLT2 inhibitors ===

Bsumida1 at 01:28, 3 August 2022

2022-08-03T01:28:56Z

← Older revision		Revision as of 18:28, 2 August 2022
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	''Consider continuing buprenorphine/methadone therapy''		''Consider continuing buprenorphine/methadone therapy''

	* For patients on opioid agonist therapy with buprenorphine or methadone, consider continuing home dosing in the perioperative period. Expect higher than usual/more frequent dosing requirements of full agonist mu-receptor agents (i.e. fentanyl, hydromorphone) for adequate pain control. Consider non-opioid adjuncts (Tylenol, NSAIDs, GABA agonists, regional techniques, ketamine infusions).		* For patients on opioid agonist therapy with buprenorphine or methadone, consider continuing home dosing in the perioperative period. May require dose reduction of buprenorphine pre-operatively if at doses >8 mg/day.
			*Expect higher than usual/more frequent dosing requirements of full agonist mu-receptor agents (i.e. fentanyl, hydromorphone) for adequate pain control.
			*Consider non-opioid adjuncts (Tylenol, NSAIDs, GABA agonists, regional techniques, ketamine infusions).

	== Other ==		== Other ==

Bsumida1 at 01:27, 3 August 2022

2022-08-03T01:27:23Z

← Older revision		Revision as of 18:27, 2 August 2022
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	=== Opioids ===		=== Opioids ===
			''Consider continuing buprenorphine/methadone therapy''

			* For patients on opioid agonist therapy with buprenorphine or methadone, consider continuing home dosing in the perioperative period. Expect higher than usual/more frequent dosing requirements of full agonist mu-receptor agents (i.e. fentanyl, hydromorphone) for adequate pain control. Consider non-opioid adjuncts (Tylenol, NSAIDs, GABA agonists, regional techniques, ketamine infusions).

	== Other ==		== Other ==

Tony.Wang at 16:45, 4 May 2021

2021-05-04T16:45:42Z

← Older revision		Revision as of 09:45, 4 May 2021
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	== Hematologic ==		== Hematologic ==

	=== Anticoagulation (e.g. warfarin~~, heparin~~, DOAC) ===		=== Anticoagulation (e.g. warfarin, DOAC) ===
	''Case-by-case basis balancing increased risk of intraoperative blood loss with prevention of thromboembolic complication''		''Case-by-case basis balancing increased risk of intraoperative blood loss with prevention of thromboembolic complication''

Tony.Wang: Anticoagulation therapy

2021-05-04T16:17:58Z

Anticoagulation therapy

← Older revision		Revision as of 09:17, 4 May 2021
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	== Hematologic ==		== Hematologic ==

	=== Antiplatelet ~~therapy~~ (e.g. aspirin, clopidogrel) ===		=== Anticoagulation (e.g. warfarin, heparin, DOAC) ===
	''~~Controversial due to~~ balancing increased risk of intraoperative blood loss with prevention of thromboembolic complication''		''Case-by-case basis balancing increased risk of intraoperative blood loss with prevention of thromboembolic complication''

			* AC should be continued if:
			** risk factors of recent stroke, MI, atrial fibrillation, or prosthetic heart valve are present
			* AC should be discontinued if:
			** anticipated high surgical blood loss (e.g. CABG)
			** procedure lasting longer than 45 min
			** there is heavy consequence of bleeding (e.g. neurosurgical procedure)
			* Timing of discontinuation:
			** Discontinue warfarin 5 days before surgery (with PT/INR day of surgery) with consideration for heparin bridging
			** Discontinue DOAC 1-2 days before surgery depending on bleeding risk

			=== Antiplatelet (e.g. aspirin, clopidogrel) ===
			''Case-by-case basis balancing increased risk of intraoperative blood loss with prevention of thromboembolic complication''

	* DAPT should be continued if:		* DAPT should be continued if:
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	** there is heavy consequence of bleeding (e.g. neurosurgical procedure)		** there is heavy consequence of bleeding (e.g. neurosurgical procedure)

	~~Ultimately~~, decision is ~~made on patient-~~by~~-patient basis after thorough discussion between~~ surgeon and cardiologist		Ideally, a decision is facilitated by surgeon and cardiologist discussion.

	=== Nonsteroidal antiinflammatory drugs (NSAID) ===		=== Nonsteroidal antiinflammatory drugs (NSAID) ===

Tony.Wang: NSAIDs

2021-05-04T16:01:10Z

NSAIDs

← Older revision		Revision as of 09:01, 4 May 2021
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	* Shown to prevent vascular events perioperatively		* Shown to prevent vascular events perioperatively

	== ~~Heme~~ ==		== Hematologic ==

	=== Antiplatelet therapy (e.g. aspirin, clopidogrel) ===		=== Antiplatelet therapy (e.g. aspirin, clopidogrel) ===
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	Ultimately, decision is made on patient-by-patient basis after thorough discussion between surgeon and cardiologist		Ultimately, decision is made on patient-by-patient basis after thorough discussion between surgeon and cardiologist

			=== Nonsteroidal antiinflammatory drugs (NSAID) ===
			Discontinue 24 hr prior to surgery

			* Increased risk of perioperative bleeding
			* Could consider continuing if patient's pain control outweighs risk of surgical bleeding

	== Endocrine (Diabetes) ==		== Endocrine (Diabetes) ==

Tony.Wang: Antiplatelet therapies (aspirin, clopidogrel)

2021-05-04T15:55:15Z

Antiplatelet therapies (aspirin, clopidogrel)

← Older revision		Revision as of 08:55, 4 May 2021
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	== Heme ==		== Heme ==

	=== ~~Anticoagulation~~ ===		=== Antiplatelet therapy (e.g. aspirin, clopidogrel) ===
			''Controversial due to balancing increased risk of intraoperative blood loss with prevention of thromboembolic complication''

	~~=== Antiplatelets ===~~		* DAPT should be continued if:
			** recent stent or bypass procedures, given high likelihood of stenosis
			** non-cardiac procedure
			* DAPT should be discontinued if:
			** there is heavy consequence of bleeding (e.g. neurosurgical procedure)

			Ultimately, decision is made on patient-by-patient basis after thorough discussion between surgeon and cardiologist

	== Endocrine (Diabetes) ==		== Endocrine (Diabetes) ==

Tony.Wang: Added SERMs and bisphosphonates

2021-05-04T15:39:28Z

Added SERMs and bisphosphonates

← Older revision		Revision as of 08:39, 4 May 2021
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	* If continued, requires perioperative VTE prophylaxis		* If continued, requires perioperative VTE prophylaxis

	=== Selective estrogen receptor modulators (~~SERMs~~) ===		=== Selective estrogen receptor modulators (SERM) ===
			''Continue''

			* Should be taken with VTE prophylaxis to offset increased VTE risk

			=== Bisphosphonates ===
			''Discontinue day of surgery''

			* Unable to be taken as recommended (with >8 oz water) due to NPO status

	== Pulmonary ==		== Pulmonary ==

Tony.Wang: Endocrine

2021-05-04T15:23:16Z

Endocrine

@@ Line 49: / Line 49: @@
 === Antiplatelets ===
-== Endocrine ==
+== Endocrine (Diabetes) ==
 === Glucocorticoids ===
@@ Line 86: / Line 131: @@
 * If continued, requires perioperative VTE prophylaxis
 == Pulmonary ==

Chris.Rishel at 12:02, 15 April 2021

2021-04-15T12:02:23Z

← Older revision		Revision as of 05:02, 15 April 2021
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	** Hydrocortisone 80 mg		** Hydrocortisone 80 mg
	** Methylprednisolone 16 mg		** Methylprednisolone 16 mg
	** Prednisone ~~20mg~~		** Prednisone 20 mg
	* No stress dose is indicated if daily less less than:		* No stress dose is indicated if daily less less than:
	** Any dose of steroid taken for less than 3 weeks		** Any dose of steroid taken for less than 3 weeks