Discontinuation and Reinstitution of Medications During the
Discontinuation and Reinstitution of Medications During the
Purpose: The issues regarding the discontinuation and reinstitution of long-term therapies, including cardiovascular agents, anticoagulants and antiplatelet agents, central nervous system agents, and herbal medicines, in the perioperative period are discussed.
Summary: It is estimated that one fourth of all patients undergoing a surgical procedure are taking long-term medications. The issues surrounding the decision to discontinue such medications before surgery and when to reinstitute them are complex. In the preoperative period, it is important to avoid the use of medications that may negatively interact with anesthetic agents. Postoperatively, the concern shifts toward avoiding withdrawal symptoms that may develop and possible progression of the underlying disease if the medications are not restarted in a timely fashion. The potential for decreased gastrointestinal motility in the postoperative patient, which may reduce the efficacy of oral medications, must also be considered. Antihypertensive medications may cause cardiovascular complications, such as hypotension or myocardial ischemia. Psychoactive medications may cause prolonged sedation and withdrawal symptoms may develop. Antithrombotic agents may increase the risks of bleeding during surgery. Several herbal medicines may cause a combination of these effects.
Conclusion: The decision to withhold and restart medications should be based on available clinical data and expert opinion. Health care professionals should exercise diligence in obtaining an accurate medication history on all preoperative patients and in reviewing the medications in the postoperative orders.
Medication use in the perioperative period is a complex issue. Patients admitted for surgical procedures may be receiving a variety of medications for the treatment of acute or chronic conditions. Some of these patients may be stabilized on their medication regimens, and discontinuation may be problematic in controlling the underlying disease. Discontinuation of long-standing medications in these patients may also lead to the development of withdrawal symptoms.
The role of the pharmacist in the preoperative and postoperative periods is an important one. In 2000, 23.2 million surgical procedures were performed. Studies have shown that as many as 25% of patients undergoing surgery regularly take medications. Combining these two facts with the estimated error rate of 5% in hospitalized patients, the significance of the pharmacist's role in this setting is apparent. Obtaining a patient's medication history, communicating it to the surgeon or anesthesiologist, and providing insight into the pharmacologic implications of continuing or withholding these medications are a few of the potential interventions a pharmacist may perform. It is important to understand the potential benefits and complications associated with stopping and restarting these medications. The focus of this review is to understand the general principles surrounding perioperative drug use and evaluate selected classes of agents the pharmacist may encounter.
Purpose: The issues regarding the discontinuation and reinstitution of long-term therapies, including cardiovascular agents, anticoagulants and antiplatelet agents, central nervous system agents, and herbal medicines, in the perioperative period are discussed.
Summary: It is estimated that one fourth of all patients undergoing a surgical procedure are taking long-term medications. The issues surrounding the decision to discontinue such medications before surgery and when to reinstitute them are complex. In the preoperative period, it is important to avoid the use of medications that may negatively interact with anesthetic agents. Postoperatively, the concern shifts toward avoiding withdrawal symptoms that may develop and possible progression of the underlying disease if the medications are not restarted in a timely fashion. The potential for decreased gastrointestinal motility in the postoperative patient, which may reduce the efficacy of oral medications, must also be considered. Antihypertensive medications may cause cardiovascular complications, such as hypotension or myocardial ischemia. Psychoactive medications may cause prolonged sedation and withdrawal symptoms may develop. Antithrombotic agents may increase the risks of bleeding during surgery. Several herbal medicines may cause a combination of these effects.
Conclusion: The decision to withhold and restart medications should be based on available clinical data and expert opinion. Health care professionals should exercise diligence in obtaining an accurate medication history on all preoperative patients and in reviewing the medications in the postoperative orders.
Medication use in the perioperative period is a complex issue. Patients admitted for surgical procedures may be receiving a variety of medications for the treatment of acute or chronic conditions. Some of these patients may be stabilized on their medication regimens, and discontinuation may be problematic in controlling the underlying disease. Discontinuation of long-standing medications in these patients may also lead to the development of withdrawal symptoms.
The role of the pharmacist in the preoperative and postoperative periods is an important one. In 2000, 23.2 million surgical procedures were performed. Studies have shown that as many as 25% of patients undergoing surgery regularly take medications. Combining these two facts with the estimated error rate of 5% in hospitalized patients, the significance of the pharmacist's role in this setting is apparent. Obtaining a patient's medication history, communicating it to the surgeon or anesthesiologist, and providing insight into the pharmacologic implications of continuing or withholding these medications are a few of the potential interventions a pharmacist may perform. It is important to understand the potential benefits and complications associated with stopping and restarting these medications. The focus of this review is to understand the general principles surrounding perioperative drug use and evaluate selected classes of agents the pharmacist may encounter.