Essential Guide to Medication Management Before Surgery

Introduction:

Preparing for surgery involves more than just mental readiness and fasting. Proper medication management in the days leading up to your procedure is crucial for your safety and optimal surgical outcomes. This comprehensive guide will walk you through how to handle various medications before surgery. However, remember that while this information is thorough, it’s not a replacement for personalized medical advice. Always follow the specific instructions provided by your healthcare team.

Medications to Continue Until Surgery Day:

1. Pain Medications:

– GABA Agonists (e.g., Gabapentin, Pregabalin): Continue taking these as usual, including on surgery day. They help with neuropathic pain and can aid post-operative pain management.
– Opioids (e.g., Codeine, Morphine, Tramadol): Management varies, so follow your doctor’s advice. Discuss your opioid use with your anesthesiologist to ensure proper pain control during and after surgery.
– Over-the-counter Pain Medications: Generally, these can be continued, but always check with your surgical team first.
– Skeletal Muscle Relaxants (e.g., Baclofen, Cyclobenzaprine): Usually continued to prevent withdrawal. Take your regular dose on surgery morning with a small sip of water.

2. Cardiovascular Medications:

Most heart and blood pressure medications should be continued, including:
– Alpha-1 Blockers
– Alpha-2 Agonists
– Antiarrhythmic Agents
– Beta Blockers
– Calcium Channel Blockers
– Statins
– Nitrates/Vasodilators

These medications help maintain cardiovascular stability during surgery. Take your usual morning dose with a small sip of water, even if fasting. Note that some blood pressure medications like ACE inhibitors or ARBs might be held on surgery day – follow your doctor’s guidance.

3. Antiretroviral/Antiviral Agents:

If you’re on antiretroviral therapy for HIV or other antiviral medications, it’s generally recommended to continue without interruption to prevent viral resistance or rebound.

4. Endocrine Medications:

– Thyroid Medications: Continue as usual to maintain proper hormone levels.
– Glucocorticoids: If on long-term steroid therapy, continue to prevent adrenal insufficiency. Your doctor may even increase the dose around surgery time.
– Aromatase Inhibitors: Typically continued for patients with hormone-receptor-positive breast cancer.

5. Gastrointestinal Medications:

Acid-reducing medications like Proton Pump Inhibitors and H2 Receptor Blockers are usually continued to reduce aspiration risk during surgery.

6. Neurological/Psychiatric Medications:

Most should be continued to maintain mental health stability and prevent withdrawal. This includes:
– Anticholinesterase Inhibitors
– Antiepileptic Agents
– Anti-Parkinson Agents
– Antianxiety Agents
– Antipsychotics
– Mood Stabilizers
– Most Antidepressants

7. Pulmonary Medications:

Asthma and COPD medications should generally be continued, including:
– Inhaled Anticholinergic Agents
– Inhaled Beta-2 Agonists
– Leukotriene Inhibitors

Use your inhalers as usual on surgery morning to maintain optimal lung function.

8. Urinary Agents:

Medications for benign prostatic hyperplasia and overactive bladder are typically continued. However, discuss alpha-1 blockers with your surgeon if you’re having eye surgery, as they can affect pupil dilation.

Medications to Stop One Day Before Surgery:

1. Antimigraine Agents (“triptans”):

Stop these one day before surgery due to their effects on blood vessels. Discuss alternative treatments for migraines if needed.

2. Non-statin Lipid Lowering Agents:

Medications like fenofibrate or ezetimibe are usually stopped the day before surgery. This brief pause shouldn’t significantly affect cholesterol levels.

3. Theophylline:

This asthma/COPD medication is typically stopped the day before due to its narrow therapeutic window and potential anesthesia interactions.

Medications to Stop on Surgery Day:

1. ACE Inhibitors and ARBs:

Often held on surgery morning as they can interact with anesthesia and cause excessive blood pressure drops.

2. Diuretics:

“Water pills” are typically held on surgery day to avoid dehydration and electrolyte imbalances.

Medications Requiring Special Consideration:

1. Diabetes Medications:

Management is crucial and individualized. Insulin regimens often need adjustment, and oral medications are typically held on surgery day. SGLT2 inhibitors should be stopped three days before surgery due to diabetic ketoacidosis risk.

2. Blood Thinners and Antiplatelet Medications:

Management depends on your specific risk factors and surgery type. Some may need to be stopped several days before, while others might be continued. Always follow your doctor’s specific instructions.

3. Immunosuppressants and Antirheumatic Agents:

These require careful consideration. Some may be continued to prevent disease flares, while others might need to be temporarily stopped. Consult with your rheumatologist or transplant physician for personalized advice.

4. Hormone Therapies:

Medications like postmenopausal hormone therapy or tamoxifen might need to be stopped several weeks before surgery due to increased blood clot risk. Discuss the risks and benefits with your doctor.

5. Oral Chemotherapy:

Management is highly individualized. Always consult with your oncologist for specific instructions.

6. Herbal Supplements and Vitamins:

Generally, these should be discontinued 7 days before surgery as they can interact with anesthesia or affect blood clotting. Always inform your surgical team about any supplements you’re taking.

Key Points to Remember:

1. Always provide a complete, up-to-date list of all your medications, including over-the-counter drugs and supplements, to your healthcare team.

2. Follow your doctor’s instructions carefully. If anything is unclear, don’t hesitate to ask questions.

3. For medications you’re continuing, take your usual morning dose with just a small sip of water on surgery day, unless instructed otherwise.

4. If you’re unsure about a medication, always check with your healthcare provider rather than making decisions on your own.

5. Be prepared to discuss your medication history during your pre-operative assessment. This includes any recent changes or temporary medications you’ve been taking.

6. If you use inhalers, bring them with you to the hospital on the day of surgery.

7. After surgery, don’t restart any medications without consulting your healthcare team first. They’ll provide guidance on when and how to resume your regular medication regimen.

Conclusion:

Proper medication management before surgery is a critical step in ensuring a safe procedure and smooth recovery. While this guide provides comprehensive information, remember that your specific medication plan may differ based on your individual health status and the type of surgery you’re undergoing. Always prioritize the personalized instructions given by your healthcare team. By carefully following their guidance and openly communicating about your medications, you’re taking an active role in optimizing your surgical experience and outcome. Thank you