Risk
Not an independent demographic risk factor for surgery, but rather increased operative risk likely due to comorbidities like functional status, malnutrition, cognitive impairment and frailty.
What is age?
Starting these cardiovascular medications (which are often part of GDMT after MI and in CHF) too close to surgery has been shown to decrease the risk of MI but increase the risk of death and stroke.
What are B-blockers?
This class of diabetes drugs should be held perioperatively due to the risk of delayed gastric emptying. And weekly dose should be held the week prior.
What are Glucagon-like peptide-1(GLP-1) receptor agonists?
Although not routinely done the package insert says to stop this hormone formulation 4 weeks before major surgery due to the risk of VTE.
What are OCPs?
A general rule (time period before surgery) to tell patients for stopping herbal medications before surgery.
What is one week?
This anthropometric description is not an independent risk factor for surgery except maybe in cardiac surgery and in other surgeries it may increase the risk of PE and maybe wound infections.
What is obesity?
This group of (non B-blocker) medications has been shown to decrease mortality in heart surgery and generally to decrease the perioperative risk of ischemia and atrial arrythmias. (So we continue them perioperatively.)
What are calcium channel blockers?
Stop these drugs 3-4 days before surgery due to risks including euglycemic DKA.
What are SGLT2 inhibitors (Sodium-glucose cotransporter-2 inhibitors)?
This formulation of HRT dose estrogen may have a lower risk of VTE.
What is transdermal?
This herbal medication for mood disorders can decrease the effect of several anesthetic induction drugs via induction of the cytochrome p450 hepatic metabolism.
What is St. John's wort?
This respiratory condition may put you at risk for reintubation and a post-op ICU stay, and would be worth a STOP-BANG.
What is obstructive sleep apnea?
These drugs can blunt compensatory renin-angiotensin system during surgery and result in prolonged hypotension. But failing to restart them within 48 hours increases 30 day mortality.
What are ACE inhibitors and ARBs?
Percentage to decrease basal insulin the day of surgery.
What is 25-50%
Whether to stop this hormone-modulating drug may depend on its indication: breast cancer treatment, breast cancer prevention, or osteoporosis.
What are SERMS (Selective estrogen receptor modulators)?
This drug you can consider tapering to 12-16 mg/day over 2-3 days preoperatively.
What is buprenorphine?
This autosomal dominant condition is important to ask about during the family history in the preoperative exam.
What is malignant hyperthermia?
These drugs you should consider continuing perioperatively to prevent a rebound hypertension but initiation preoperatively is associated with increased risk of hypotension and cardiac arrest.
What are Alpha 2 Agonists (clonidine)?
This oral drug to treat a thyroid condition has such a long half-life you can avoid giving the IV form if someone will resume eating in 5-7 days. But if you do give IV you reduce the dose by this percentage.
What is levothyroxine? What is 20%?
Options preoperatively to decrease VTE risk include stopping these hormone formulations for 2-4 weeks before surgery, decreasing a dose for example to 1mg of estradiol, or if continuing the usual dose talk with the surgeon.
What are feminizing hormones?
Discussion should be held preoperatively about holding this medication, a competitive antagonist for OUD and AUD, preoperatively. Risks include increased risk of respiratory suppression due to a transient exaggerated response to opioid agonists, and pulse oximetry and ECG monitoring should be utilized.
What is naltrexone?
Statistically the percentage of "normal" lab test values which may be "abnormal" because they fall outside 2 standard deviations of the mean.
What is 5%
This class of cholesterol drugs should be continued perioperatively as opposed to some other classes which should be held the day of surgery due to increased risk of myopathy and rhabdomyolysis.
What are statins?
Although the risk of osteonecrosis may persist long-term the Am. Assoc. of Oral and Maxillofacial Surgeons says hold this medication for 2 months before dental surgery.
What are bisphosphonates?
If a patient is on prednisone 5mg a day or less or have taken steroids for less than 3 weeks then he/she doesn't need this dosing intervention perioperatively.
What are stress dose steroids? e.g. hydrocortisone 100mg q8 hours
This adjunct has proved effective in post-op pain management after known painful surgeries as an adjunct to help decrease opioid needs. However, they should be avoided for patients over 75yo and may increase the risk of respiratory suppression when used with opioids.
What are gabapentinoids?