Perioperative medication management: a case-based review of general principles.

Saber, Wael

doi:10.3949/ccjm.73.suppl_1.s82

Cited by 12 publications

(18 citation statements)

References 20 publications

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“…The current medication guideline used at the perioperative clinic in our institution recommends that both ACEIs and ARBs be discontinued on the morning of non-cardiac surgery 24. There are no national or international guidelines that delineate a standard of care in the use of these agents in the perioperative period.…”

Section: Evidence Against Raas Antagonists In the Perioperative Settingmentioning

confidence: 99%

Renin–angiotensin system antagonists in the perioperative setting: clinical consequences and recommendations for practice

Aurón

Harte

Kumar

et al. 2011

Postgraduate Medical Journal

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There are no existing guidelines supporting the withdrawal or continuation of renineangiotensinealdosterone system (RAAS) antagonists in the preoperative setting. RAAS antagonists include ACE inhibitors, angiotensin II receptor subtype 1 blockers and direct renin inhibitors (eg, aliskiren), as well as the aldosterone antagonists. The use of these agents before surgery has been associated with a variable incidence of hypotension during the initial 30 min after induction of anaesthesia; however, these hypotensive episodes have not been conclusively linked to any significant postoperative complications, although recent data suggest an increase in postoperative morbidity and mortality in patients undergoing coronary artery bypass grafting. Further studies are required to be able to demonstrate if the organ-protective benefits of RAAS antagonists justify their continuation in the perioperative setting. Temporary withdrawal of RAAS antagonists in these patients may prevent or attenuate intraoperative hypotension and hypovolaemia. Alternatively, the increase in RAAS activity and blood pressure expected with cessation of RAAS antagonist therapy may impair regional circulation secondary to an increase in systemic vascular resistance. Full discussion of the potential implications of perioperative RAAS antagonist therapy with the surgical team is important, and strategies to ensure careful monitoring and maintenance of adequate intravenous volume before induction of anaesthesia are essential.

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Section: Evidence Against Raas Antagonists In the Perioperative Settingmentioning

confidence: 99%

Renin–angiotensin system antagonists in the perioperative setting: clinical consequences and recommendations for practice

Aurón

Harte

Kumar

et al. 2011

Postgraduate Medical Journal

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“…Potential benefits of continuing α 2 ‐agonists perioperatively include decrease in the stress response to surgery procedures and the reduction of anaesthetic doses because of their sedative, anxiolytic, analgesic and anti‐shivering properties (32). Three recommendations were published in accordance with our recommendation (29, 32, 34).…”

Section: Resultsmentioning

confidence: 99%

Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus

Castanheira

Fresco

Macedo

2010

Journal of Clinical Pharmacy and Therapeutics

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What is known and Objective: The worldwide volume of surgery is huge and the number of interventions performed is increasing as a result of advances in technological resources and refinement of medical teams' expertise, in a progressively elderly and sick population. Consequently, half of the general surgical patients take medications unrelated to surgery. Evidence-based guidelines for perioperative medication management are therefore critically needed to improve safety in surgery. The purpose of this work was to develop practice recommendations for the management of chronic medication in the perioperative period. Methods: A systematic review and a formal consensus were performed. A search in Medline, Embase, ISI Web of Knowledge and Medscape were conducted in September 2008. Two independent investigators assessed the quality of selected studies. Evidence-based guidelines with strength classification were found for some therapeutic groups. Those guidelines were adopted and no further analysis was performed. For the other therapeutic groups, a formal consensus was used, based on a modified nominal group technique: 32 statements were formulated considering the literature retrieved. A selected panel of experts was asked by electronic mail to rate their level of agreement with each statement. Then, a meeting was convened and a second round survey was used to determine the final level of agreement. The statements which met the established criteria of consensus were developed into practice recommendations, supported by the results of the formal consensus and the evidencebased findings from systematic review. Results and Discussion: A total of 23 studies were included in the systematic review; three randomized controlled trials (RCTs), 13 cohorts, two case-controls and three clinic-cases. Twenty-two practice recommendations for the management of chronic medication in the perioperative period resulted from formal consensus. What is new and Conclusion: Epidemiological studies concerning the perioperative management of chronic medications are clinically heterogeneous and there are few RCTs available. However, the formal consensus method proved to be a helpful tool to integrate different strands of evidence for the development of practice guidelines.

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“…Arzneimittelinteraktionen kön-nen dabei zu verlängerten Krankenhausaufenthalten und erhöhter Morbidität führen [4]. Besonders auf dem Gebiet der kardiovaskulären Medikation sind in den letzten Jahren Evidenzbasierte Empfehlungen publiziert worden Der Evidenzgrad (LOE) der Empfehlungen für andere Substanzgruppen ist jedoch geringer [9,26,36].…”

Section: Einleitung ▼unclassified

Perioperatives Medikamentenmanagement

Gschiel

Fritsch²,

Böck³

2012

Dtsch med Wochenschr

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The management of chronic medication in the perioperative phase represents as a serious challenge for the involved physicians. Especially patients with elevated ASA-scores frequently suffer from multiple co-morbidities which often need numerous medications. The probability of pharmacological interactions rises with the number of these medications. Moreover it must be taken into consideration that chronic medication potentially interferes with both intravenous and inhaled anesthetics and moreover, bleeding complications are more likely to occur in patients undergoing chronic pharmacotherapy. The aim of this article is to provide a summary of the existing evidence concerning perioperative medication in patients undergoing non-cardiac surgery. Several guidelines and advisories dealing with cardiovascular medication have been published during the last decade. The main scope of these publications was on beta-blockers and other cardiovascular medication. There is less evidence on not-cardiovascular medication as in most cases only case reports and expert opinions are published. Existing epidemiologic studies on this topic are rather heterogeneous.

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Perioperative medication management: a case-based review of general principles.

Cited by 12 publications

References 20 publications

Renin–angiotensin system antagonists in the perioperative setting: clinical consequences and recommendations for practice

Renin–angiotensin system antagonists in the perioperative setting: clinical consequences and recommendations for practice

Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus

Perioperatives Medikamentenmanagement

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