MRCS Part A_ Essential Revision Notes_ Book 1

SECTION 2
Preoperative management of coexisting disease
2.1 Preoperative medications
In a nutshell ...
If a patient is having surgery:
Review pre-existing medication:
• Document preoperative medications
• Decide which drugs need to be stopped preoperatively
• Decide on alternative formulations
Prescribe preoperative medication:
• Prescribe prophylactic medication
• Prescribe medication related to the surgery
• Prescribe premed if needed
Be aware of problems with specific drugs:
• Steroids and immunosuppressants
• Anticoagulants and fibrinolytics
Review pre-existing medication
Perioperative management of pre-existing medication
Document preoperative medications
Decide whether any drugs need to be stopped before surgery
Stop oral contraceptive (OCP) or tamoxifen 4 weeks before major or limb surgery – risk of thrombosis •
Stop monoamine oxidase inhibitor (MAOI) antidepressants – they interact with anaesthetic drugs, with
cardiac risk • Stop antiplatelet drugs 7–14 days preoperatively – risk of haemorrhage
Decide on alternative formulations for the perioperative period
For example, IV rather than oral, heparin rather than warfarin
Regular medications should generally be given – even on the day of surgery (with a sip of clear fluid