Surgery - Give, Omit or Discuss? Flashcards
“Cardiac” or blood pressure medication
GIVE
EXCEPT ACEi, AT2 antagonists and diuretics
Aspirin
Usually safe to continue unless there is a high post-op bleed risk associated with the procedure
However, usually safe to STOP aspirin if used for primary prevention and this should stop 7 days pre-op
Epilepsy or Parkinson’s medication
GIVE
Asthma drugs or inhalers
GIVE
PPIs
GIVE
Thyroid medication
GIVE
Major and minor tranquilisers which are taken regularly at home
GIVE
Antidepressants
GIVE
EXCEPT irreversible MAOIS which need 2 weeks to stop pre-op
Nicotine patches
GIVE
Steroids taken regularly, including inhalers
GIVE
Immunosuppressants and cancer drugs
GIVE
Analgesics
GIVE
Diabetic treatment
Oral diabetic medication usually OMITTED on the morning of surgery
Continuation and dosing of usual insulin on the day of surgery depends upon the usual insulin regime and time of operation
The need for additional subcutaneous insulin or VRIII is NOT routine practice and depends upon the blood glucose levels and number of meals likely to be missed.
Clopidrogrel
STOP 7 days pre-op
Dipyridamole
STOP (if used alongside another antiplatelet) 24 hours pre-op
GIVE if used on its own
Warfarin
STOP
Take last dose of warfarin six days before surgery
Start LMWH 2 days after stopping warfarin
OMIT LMWH on the morning on the surgery and stop unfractionated heparin 6 hours before surgery
NOACs
STOP several days before surgery to allow for reduction in their anticoagulant effect (depending on renal function and half life)
Lithium
OMIT 24 hours pre-op unless a minor procedure
Medications with are not essential in the short term (e.g. vitamins, iron, laxatives, osteoporosis treatment, antacid meds)
STOP
Anticholinesterases for dementia
STOP Galantamine and Rivastigmine 24 hours pre-op
Donepezil not normally stopped due to long half-life, and would need to be stopped 2-3 weeks in advance (too much of a risk of decline of patient to do this)
Combined oral contraceptive pill or HRT
STOPPED 4 weeks before elective surgery
If not possible, ensure anti-embolism stockings and prophylactic LMWH.
ACEi
DISCUSS
These medicines may drop the BP during anaesthesia.
Local guidelines differ as to stopping or giving on the day of surgery.
Diuretics
DISCUSS
These medicines may drop the BP during anaesthesia.
Local guidelines differ as to stopping or giving on the day of surgery.
