Surgery & long-term medication

Question 1

Pt with adrenal atrophy resulting from long term corticosteroid use may..

Answer 1

suffer fall in BP UNLESS corticosteroid cover given during anaesthesia & in immediate postoperative period

Question 2

drugs NOT stopped before surgery

Answer 2

1. Anti-epileptics
2. Anti-parkinson
3. Antipsychotics
4. Anxiolytics
5. Bronchodilators
6. Cardiovascular drugs
7. Glaucoma drugs
8. Immunosuppressants
9. Drugs of dependence
10. Thyroid/Anti-thyroid drugs

Question 3

Antiplatelets / oral anticoagulants during surgery

Answer 3

assess relative risk to either stop or replace with
→ Heparin (unfractionated) or LMW heparin

STABLE angina ~ perioperative aspirin only continued IF high thrombotic risk (e.g. recent ACS/stents/Stroke)

Question 4

Drugs STOPPED before surgery

Answer 4

1. Combined hormonal contraceptives
2. MAOIs
3. TCA (not need to be stopped but increased risk of arrhythmias / hypotension)
4. Lithium (24h before major but continue for minor)
5. K-sparing diuretics (Withheld on morning of surgery)
6. ACE/ARBs (24h before surgery)
7. Herbal medications