[Preoperative management of chronic medications].
This review focuses on potential drug interactions between anaesthetic drugs or techniques and chronic medications in patients scheduled for surgery. The vast majority of therapeutics can be continued until the morning of surgery. However, for some drugs such as ACE inhibitors, there is strong evidence to recommend their discontinuation prior to surgery. When juged necessary, interruption of chronic therapeutic needs to be anticipated and planned. In the other hand, for other drugs such as beta-blockers or L-Dopa, acute withdrawal is associated with documented adverse outcome. As a result, such drugs have to be continuing throughout the operative period. Although a general consensus exists for many medications, there are still controverses as to the management of antithrombotic drugs and some central nervous system agents. Advances in anaesthesia include knowledge on the mechanisms involved in drug interactions, which allows us to improve the preoperative management of chronic therapeutics.
Baillard
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C
Service d'anesthésie-réanimation, UPRES 39-04, hôpital Avicenne, 125, avenue de Stalingrad, 93009 Bobigny, France. christophe.baillard@avc.ap-hop-paris.fr
D000777:Anesthetics / Q000009:adverse effects; D000818:Animals; D002317:Cardiovascular Agents / Q000009:adverse effects; D002491:Central Nervous System Agents / Q000009:adverse effects; D000075202:Contraindications; D004347:Drug Interactions; D004358:Drug Therapy; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D008134:Long-Term Care; D019990:Perioperative Care; D008517:Phytotherapy
D000777:Anesthetics; D002317:Cardiovascular Agents; D002491:Central Nervous System Agents; D005343:Fibrinolytic Agents