Which of these can be safely stopped before an abdominal surgery ?
- ACE inhibitors
- Beta blocker
- 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.