Perioperative Assessment and Optimization in Major Colorectal Surgery: Medication Management

Abstract

The colorectal surgeon is often faced with medications that can be challenging to manage in the perioperative period. In the era of novel agents for anticoagulation and immunotherapies for inflammatory bowel disease and malignancy, understanding how to advise patients about these medications has become increasingly complex. Here, we aim to provide clarity regarding the use of these agents and their perioperative management, with a particular focus on when to stop and restart them perioperatively. This review will begin with the management of both nonbiologic and biologic therapies used in the treatment of inflammatory bowel disease and malignancy. Then, discussion will shift to anticoagulant and antiplatelet medications, including their associated reversal agents. Upon finishing this review, the reader will have gained an increased familiarity with the management of common medications requiring modification by colorectal surgeons in the perioperative period.

Effect of Ornithine α-Ketoglutarate on Intestinal Microbiota and Serum Inflammatory Cytokines in Dextran Sulfate Sodium Induced Colitis

“…The loss of a microbiome significantly reduces the inflammatory response of the large intestine after DSS exposure and impairs intestinal barrier function. The current medications used to treat UC involve aminosalicylates, glucocorticoids, corticosteroids, and immunosuppressants [6,7]. However, these drugs frequently only alleviate symptoms instead of curing disease and may induce substantial side effects.…”