Medications in Surgery

 

Medications to Continue

 

 

Medication Class	Example	Recommendation
Beta Blockers	Metoprolol	Continue to manage heart rate and avoid withdrawal effects.
Antipsychotics	Haloperidol	Continue, monitoring for interactions with anesthesia.
Statins	Atorvastatin	Continue to prevent vascular complications.
Alpha 2 Agonists	Clonidine	Continue to prevent rebound hypertension.
Calcium Channel Blockers	Diltiazem	Continue, they’re safe with theoretic benefits during surgery.

 

Medications to Discontinue

 

 

Medication Class	Example	Recommendation
ACE Inhibitors	Lisinopril	Withhold on day of surgery to avoid hypotension.
NSAIDs	Ibuprofen	Discontinue to decrease bleeding risk, usually 24 hours prior.
Diuretics	Furosemide	Withhold on morning of surgery to reduce hypovolemia risk.
Herbal Medications	Ginkgo	Discontinue at least 24 hours prior to surgery to reduce risks.

 

Preoperative Management of Diabetes Mellitus

1. Type 2 Diabetes (on oral hypoglycemics)

Major Surgery: Discontinue oral hypoglycemic agents before surgery to avoid the risk of hypoglycemia when fasting.
Minor Surgery: Continue oral hypoglycemics as usual, monitoring blood glucose levels closely.

2. Type 1 Diabetes (on insulin)

Major Surgery: Implement a sliding scale insulin regimen preoperatively and continue it until regular oral intake is re-established. Consider IV insulin and dextrose to maintain stable glucose levels.
Minor Surgery: Omit insulin on the day of surgery due to reduced intake but monitor glucose levels.

General Guidelines for Both Types

After surgery, resume the previous diabetes regimen once the patient can eat and drink.
Monitor blood glucose every 4 hours to adjust therapy as needed and prevent both hyperglycemia and hypoglycemia.