Beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia?
OBJECTIVE
As day surgery continues to expand, more patients will be encountered who are chronically taking a range of cardiovascular medications for the management of hypertension and ischaemic heart disease. This review will consider the available evidence relating to whether or not these medications should be continued throughout the perioperative period in ambulatory surgical patients.


RESULTS
There has been relatively little research in this area which is specific to ambulatory surgery and much of the available evidence from major surgery has been assembled over the many years that these medications have been in use. In order to provide a comprehensive and balanced review, we have considered relevant evidence outside of the usual review period.


CONCLUSIONS
Patients should continue to take beta-blockers and calcium channel blockers on the day of surgery. Continuing angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers increases the likelihood of intraoperative hypotension. This can be reduced by withholding these drugs, but will also respond to simple treatments without any apparent adverse outcomes. It may therefore simplify instructions to patients if they are told to take all cardiac medications as normal.
Smith
Ian
I
University Hospital of North Staffordshire, Stoke-on-Trent, UK. damsmith@btinternet.com
Jackson
Ian
I
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000556:Ambulatory Surgical Procedures; D000758:Anesthesia; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004347:Drug Interactions; D006331:Heart Diseases / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007431:Intraoperative Complications / Q000139:chemically induced / Q000517:prevention & control; D059065:Medication Reconciliation; D019990:Perioperative Care / Q000379:methods; D059035:Perioperative Period
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers