Which of these can be safely stopped before an abdominal surgery

NEET PG Pharmacology
#1

Which of these can be safely stopped before an abdominal surgery ?

    1. ACE inhibitors
    1. Beta blocker
    1. Statins
    1. Steroids

0 voters

EXP:

  • All antihypertensives should be continued in peri-operative period except ACE inhibitors, Angiotensin receptor blockers and diuretics. ACE inhibitors and ARBs should be stopped 24 hours before surgery to prevent intraopera-tive hypotension. Diuretics should be stopped once the patient is kept NPO (Nil per oral) to prevent intraoperative volume depletion and electrolyte abnormalities.
  • Statins should be continued if the patient is taking them, especially because preoperative withdrawal has been as­sociated with a 4.6-fold increase in troponin release and a 7.5-fold increased risk of myocardial infarction (MI) and cardiovascular death following major vascular surgery.
  • Corticosteroid therapy in excess of prednisone 5 mg/ day or equivalent for more than five days in the 30 days preced­ing surgery might predispose patients to acute adrenal insufficiency in the perioperative period. Surgical procedures typically result in cortisol release of 50-150 mg/ day, which returns to baseline within 48 hours. Therefore, the recom­mendation is to continue a patient’s baseline steroid dose and supplement it with stress-dose steroids tailored to the severity of operative stress.

General principles are

  • Perioperative medication use should be tailored for each patient.
  • Medications should be continued to avoid perioperative disease decompensation and withdrawal.
  • Medications that interact with anesthesia or increase the risk of perioperative complications might need to be stopped.
  • Stop ACEI/ARB 24 hours before surgery.
  • Stop diuretics once NPO.
  • Continue statins.
  • Continue CNS-active drugs.
  • Insulin may require adjustment.
  • Stop metformin 24 hours before surgery.
  • Stop sulfonylureas the night before surgery.
  • Stop OCPs and HRT four weeks before surgery, if possible.
  • Stop nonselective NSAIDs two to three days before surgery, but continue COX-2 inhibitors.
  • Continue outpatient dosing of corticosteroids and add a stress dose.
  • Stop DMARDs and biologics one week before surgery.
  • Stop herbal medicines one to two weeks before surgery.