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#1850
List of Medications should be avoided before surgery

Cardiovascular

Beta blockers (metoprolol, atenolol, others)

Should be continued until and including the day of operation

Pletal (cilostazol)

Should be discontinued 7 days prior to elective surgery where surgical bleeding potential exists

Ace inhibitors (ACEI) & Angiotensin receptor blockers (ARB) (captopril, lisinopril, losartan, candesartan, others)

These should be continued until the day before the operation, but discontinued on the day of the operation. This applies to patients booked for general anesthesia. Patients booked for MAPS should continue these medications until and including the day of the operation.

Calcium channel blockers (nifedipine, diltiazem, others)

Should be continued until and including the day of the operation

Nitrates (nitroglycerin, isosorbide, others)

Should be continued until and including the day of the operation

Alpha-2 agonists (clonidine, others)

Should be continued until and including the day of the operation

Aspirin

Should be discontinued at least one week prior to the planned operation, unless specifically stated otherwise by the surgical service

Clopidogrel (plavix)

Should be discontinued at least one week prior to the planned operation, unless specifically stated otherwise by the surgical service

Patients taking clopidogrel (plavix) or aspirin for coronary stents should be seen by an anesthesiologist in the preoperative anesthesia clinic. Do not discontinue either aspirin or clopidogrel in patients with coronary stents unless given specific permission to do so by the cardiologist who prescribed these medications.

Oral anticoagulants (warfarin, coumadin)
Should be discontinued at least 5 days prior to the planned operation, unless specifically stated otherwise by the surgical service

Diuretics (furosemide, hydrochlorothiazide, others)

Should be taken until the day before the operation, but discontinued the day of the operation

Cardiac rhythm management medications (digoxin, beta-blockers, quinidine, amiodarone, others)

Should be continued until and including the day of the operation

Statins (atorvastatin, simvastatin, others)

Should be continued until and including the day of the operation

Cholesterol lowering medications

Should be taken until the day before the operation, but discontinued the day of the operation

Central Nervous System Medications

Anticonvulsants (phenytoin, tegretol, others)

Should be continued until and including the day of the operation

Antidepressants (imipramine, sertraline, others)

Should be continued until and including the day of the operation

Monoamine oxidase inhibitors (very rarely used)

Should be discontinued at least 2 full weeks prior to the planned operation

Antianxiety medications (diazepam, lorazepam, others)

Should be continued until and including the day of the operation

Antipsychotics (haloperidol, risperdal, others)

Should be continued until and including the day of the operation

Lithium

Should be continued until and including the day of the operation

Antiparkinson drugs (sinemet, others)

Should be continued until and including the day of the operation

Recreational drugs (marijuana, cocaine, others)

Should be discontinued as soon as possible prior to any planned elective operation

Management of Sublingual Buprenorphine (Suboxone and Subutex)
in the Acute Perioperative Setting (pdf)

Vitamins/Nutritional Supplements

Over the counter vitamins

May be continued until the day before the planned operation
Except preparations containing vitamin E, which should be discontinued one week prior to the planned operation

Herbal/Alternative preparations

Should be discontinued at least one full week prior to the planned surgical procedure


Pulmonary Medications

Asthma medications (theophylline, inhaled steroids, others)

Should be continued until and including the day of the operation

COPD medications (theophylline, ipratropium, inhaled steroids, others)

Should be continued until and including the day of the operation

Pulmonary hypertension medications (sildenafil, prostacyclin, others)

Should be continued until and including the day of the operation


Endocrine

Insulin

http://www.med.umich.edu/preopclinic/gu ... es_mgt.pdf

Oral Hypoglycemics

Should be taken until the day before the operation, but discontinued the day of the operation

Thyroid medications (synthroid, dessicated thyroid, propylthiouracil, others)

Should be continued until and including the day of the operation

Steroids (prednisone, cortef, others)

Should be continued until and including the day of the operation


Oral contraceptives


Should be continued until and including the day of the operation
Renal

Phosphate binders, renal vitamins, iron, erythropoietin, others

Should be taken until the day before the operation, but discontinued the day of the operation

Gynecology/Urology

Prostate medications (terazosin, tamsulozsin, others)

Should be continued until and including the day of the operation

Hormonal medications

Should be continued until and including the day of the operation

Oral contraceptives

Should be continued until and including the day of the operation


Analgesics

Aspirin

Should be discontinued at least one week prior to the planned operation
Unless specifically stated otherwise by the surgical service

Opiate containing analgesics (vicodin, tylox, methadone, others)

Should be continued until and including the day of the operation, without exception

Non-steroidal anti-inflammatory compounds (ibuprofen, naproxen, others)

Should be discontinued at least 5 days prior to the planned surgical procedure

Gastrointestional

Gastroesophageal reflux (GERD) medications (ranitidine, omeprazole, others)

Should be continued until and including the day of the operation

Antiemetics (ondansetron, metaclopramide, others)

Should be continued until and including the day of the operation



STOP MEDICINE.jpg
#1851
New guidelines on antibiotics issued by WHO aims to arrest the spread of superbugs

Antibiotics should only be used to prevent infections before and during surgery and not afterwards, new guidelines issued by World Health Organisation (WHO), which aim to save lives, cut costs and arrest the spread of superbugs, said on Thursday.

Noting that surgical site infections threaten millions of lives and contribute to the spread of antibiotic resistance, WHO said in low and middle-income countries, 11% of patients who undergo surgery are infected in the process. The guidelines also said people preparing for surgery should always have a bath or shower but should not be shaved.

The global guidelines for the prevention of surgical site infection include a list of 29 concrete recommendations distilled by 20 of the world’s leading experts from 26 reviews of the latest evidence. The recommendations were also published on Thursday in The Lancet Infectious Diseases and are designed to address the increasing burden of healthcare-associated infections on both patients and healthcare systems globally.

“No one should get sick while seeking or receiving care. Preventing surgical infections has never been more important but it is complex and requires a range of preventive measures. These guidelines are an invaluable tool for protecting patients,” said Marie-Paule Kieny, WHO’s assistant, director general for health systems and innovation. surgical site infections are caused by bacteria that get in through incisions made during surgery and they threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance.

“In low and middle income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies,” WHO said.

The new WHO guidelines are valid for any country, including India, and suitable to local adaptations and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

The guidelines include 13 recommendations for the period The guidelines include 13 recommendations for the period before surgery and 16 for preventing infections during and after surgery. They range from simple precautions such as ensuring that patients bathe or shower before surgery and the best way for surgical teams to clean their hands, to guidance on when to use antibiotics to prevent infections, what disinfectants to use before incision, and which sutures to use.

The guidelines recommend that antibiotics be used to prevent infections before and during surgery only, a crucial measure in stopping the spread of antibiotic resistance. Antibiotics should not be used after surgery, as is often done.

“Sooner or later many of us will need surgery, but none of us wants to pick up an infection on the operating table. By applying these new guidelines surgical teams can reduce harm, improve quality of life, and do their bit to stop the spread of antibiotic resistance. We also recommend that patients preparing for surgery ask their surgeon whether they are following WHO’s advice,” said Ed Kelley, director of WHO’s department of service delivery and safety

By PTI (Mint Thu, Nov 03 2016)
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