Perioperative Medication Management-References

References

Pdf Summary

The document provides an extensive, referenced overview of perioperative medication management from 2023 to 2026, encompassing guideline updates, clinical studies, and consensus statements relevant to various drug classes in surgical contexts. Key focus areas include antithrombotic agents such as aspirin, clopidogrel, and newer anticoagulants, highlighting risks of bleeding versus thrombosis, and evidence-based timing for discontinuation or continuation around surgery. Multiple references analyze aspirin’s impact on bleeding and mortality post-coronary artery bypass grafting, and the American College of Chest Physicians and cardiac societies provide contemporary clinical practice guidelines on perioperative antithrombotic therapy.<br /><br />The management of cardiovascular medications is also addressed, particularly beta blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs). The literature reveals a nuanced balance between preventing perioperative cardiac events and avoiding complications like hypotension or acute kidney injury. Several studies recommend careful individualized assessment regarding withholding versus continuation of ACEIs/ARBs perioperatively.<br /><br />Statins receive significant attention for their perioperative cardiovascular protective effects, supported by randomized trials and meta-analyses suggesting reduced postoperative morbidity and mortality in both cardiac and noncardiac surgeries.<br /><br />Endocrine and diabetic medication management includes considerations for insulin, metformin, and newer agents like SGLT2 inhibitors and GLP-1 receptor agonists, emphasizing avoidance of hypoglycemia and diabetic ketoacidosis while maintaining glycemic control.<br /><br />The document also covers perioperative handling of psychiatric and neurologic medications such as selective serotonin reuptake inhibitors (SSRIs), highlighting bleeding risk and withdrawal effects, as well as antirheumatic, adrenal insufficiency, and corticosteroid therapies with guidance on stress dosing.<br /><br />Additional topics include the management of nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, diuretics, and dietary supplements. Consensus statements from organizations like SPAQI and the American Society of Anesthesiologists reflect recent multidisciplinary expert opinions and evidence to optimize medication use and minimize perioperative risks.<br /><br />Overall, the references collectively guide clinicians in evidence-based, individualized perioperative pharmacologic management to improve surgical safety and outcomes across diverse patient populations and medication classes.

Keywords

perioperative medication management

antithrombotic agents

aspirin and bleeding risk

cardiovascular medications

beta blockers

ACE inhibitors and ARBs

statins perioperative use

diabetic medication management

psychiatric medication perioperative

clinical practice guidelines