ACEI/ARBS
This common intraoperative complication is more likely when patients take ACE inhibitors or ARBs the morning of surgery.
Refractory hypotension
GLP-1 agonists delay this physiologic process, raising concern for aspiration risk.
Gastric emptying
This lab test is not reliable for monitoring DOACs such as apixaban or rivaroxaban.
INR, PT, PTT
This major society guideline strongly recommends continuing beta-blockers perioperatively in patients already taking them.
ACC/AHA guidelines
Abrupt discontinuation of SSRIs may lead to this flu-like withdrawal reaction.
Serotonin discontinuation syndrome
Anesthesia guidelines often recommend holding ACE inhibitors/ARBs this long before elective surgery to reduce vasodilatory hypotension.
Morning of surgery (or 12-24 hours before)
Current ASA guidance recommends withholding daily-dosed GLP-1 agonists this long before surgery.
24 hours
According to ASRA, apixaban should be held at least this long before neuraxial anesthesia in patients with normal renal function.
72 hours
Sudden withdrawal of beta-blockers may lead to this potentially dangerous cardiovascular response.
Rebound tachycardia/ischemia
Patients on SSRIs/SNRIs may have increased intraoperative bleeding risk due to effects on this platelet component.
serotonin-mediated platelet aggregation
Patients on ACE/ARBs who become hypotensive may respond poorly to phenylephrine but often improve with this vasopressor.
Vasopressin
For weekly-dosed GLP-1 agonists, many centers hold the medication this long pre-operatively.
Protamine reverses the anticoagulant effects of these two medications (full or partially)
Unfractionated heparin (fully); LMWH (partially)
This ultra–short-acting beta-blocker is frequently used intraoperatively for tight HR control.
Esmolol
Lithium toxicity risk increases with perioperative fluid shifts; this class of common medications should be avoided or minimized.
NSAIDS or diuretics (anything that decreases renal perfusion or increases sodium reabsorption will increase lithium reabsorption)
ACE/ARB continuation may be appropriate if this cardiac condition is present, since withdrawal could worsen decompensation.
Heart failure with reduced EF
GLP-1 agonist use may necessitate this airway precaution if there's concern for delayed gastric emptying.
Rapid Sequence Induction
This direct thrombin inhibitor must be held longer in renal dysfunction, and a normal aPTT may not guarantee safe neuraxial placement.
Dabigatran (Pradaxa)
Beta-blockers can mask early symptoms of this common postoperative complication related to glucose metabolism.
Hypoglycemia
This anesthetic medication, when combined with MAOIs, can precipitate hypertensive crisis due to unopposed catecholamine release.
Meperidine (indirect sympathomimetic)
This physiological mechanism explains why ACE/ARB therapy predisposes patients to anesthesia-induced hypotension.
Impaired RAAS-mediated vasoconstriction
GLP-1 agonists work by enhancing this hormone’s secretion in a glucose-dependent manner.
Insulin
This reversal agent specifically targets factor Xa inhibitors like apixaban and rivaroxaban.
Andexanet Alfa
Beta-blockade decreases myocardial oxygen demand by reducing these two physiologic parameters.
Antipsychotics such as haloperidol can prolong this ECG interval, raising arrhythmia risk.
QT interval