Document Detail


Chronic medications in the perioperative period.
MedLine Citation:
PMID:  9563428     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: While most chronic medications can be safely continued in the perioperative period, decisions regarding certain medications remain controversial. METHODS: We mailed a questionnaire to all 150 anesthesiology program directors in the United States, with 113 (75%) responding. Opinions regarding preoperative discontinuance or modification of selected medications were assessed. RESULTS: Antiplatelet agents are typically discontinued preoperatively, although the number of days varies widely. Few respondents discontinue tricyclic antidepressants, oral contraceptives, diuretics, or oral hypoglycemic agents. For a patient on insulin, the most popular regimen is half the patient's usual dose of neutral protamine Hagedorn insulin (50%) or no preoperative insulin (37%), whereas an insulin infusion for tight control was rarely advised. Respondents varied widely in their approach to steroid coverage, their cancellation of elective operations in patients with inadvertent aspirin ingestion, and the length of time before surgery they would discontinue warfarin. In patients with chronic atrial fibrillation, 72% of respondents favored use of a heparin window preoperatively. CONCLUSIONS: Practice variations regarding insulin regimens, steroid coverage, aspirin, and anticoagulants reflect a lack of firm evidence favoring one approach.
Authors:
K Kroenke; D Gooby-Toedt; J L Jackson
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Southern medical journal     Volume:  91     ISSN:  0038-4348     ISO Abbreviation:  South. Med. J.     Publication Date:  1998 Apr 
Date Detail:
Created Date:  1998-05-06     Completed Date:  1998-05-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0404522     Medline TA:  South Med J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  358-64     Citation Subset:  AIM; IM    
Affiliation:
Regenstrief Institute and Department of Medicine, Indiana University School of Medicine, Indianapolis 46202, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesiology*
Anticoagulants / administration & dosage
Aspirin / administration & dosage
Humans
Insulin / administration & dosage
Intraoperative Care*
Middle Aged
Patient Care Management
Pharmaceutical Preparations / administration & dosage*
Physician's Practice Patterns / statistics & numerical data*
Platelet Aggregation Inhibitors / administration & dosage
Preoperative Care*
Questionnaires
Steroids / administration & dosage
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Pharmaceutical Preparations; 0/Platelet Aggregation Inhibitors; 0/Steroids; 11061-68-0/Insulin; 50-78-2/Aspirin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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