Thematic reivew on perioperative medicinePreoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement
Section snippets
Participants and Methods
The clinical areas for the SPAQI consensus statements were chosen by SPAQI leadership on the basis of knowledge and practice gaps identified in a variety of the organization’s educational forums. Endocrine, hormonal, and urologic medications were combined for one consensus group based on the number of medications and the goal of balancing the content of all previous and forthcoming consensus statements. The members of the consensus group were faculty members at several different academic
Insulins
Appropriate adjustment of insulin therapy in the perioperative period is essential to maintain good glucose control to avoid postoperative complications of both hyperglycemia and hypoglycemia. Insulin decreases blood glucose by stimulating peripheral glucose uptake and decreasing hepatic glucose release. The time course of insulin action differs across the different insulin preparations, which primarily determines their perioperative dose adjustments. As much as possible, clinicians should
Alpha-1 Adrenergic Antagonists
Among the urologic medications discussed in this section, alpha-1 adrenergic antagonists are the most commonly prescribed drugs for initial medical treatment of benign prostatic hypertrophy (BPH). These medications antagonize the alpha-1 adrenoreceptor, thereby inhibiting smooth muscle contraction, leading to decreased smooth muscle tone in the prostatic urethra and bladder neck.49 Medications of this class have similar efficacies, but they differ in their level of uroselectivity. Less
Conclusion
Perioperative medication management is a critical part of optimal care of surgical patients. Instructional literature to support best practices in this area remains lacking, and perioperative decision making is primarily guided by knowledge of medication mechanisms of action and adverse effect profiles. Summarized in Table 1, Table 2, Table 3, Table 4, this consensus statement provides recommendations of experts in anesthesiology, internal medicine, perioperative medicine, and medical
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2024, Anesthesiology ClinicsPerioperative management of VTE risk in patients on estrogen therapy
2022, Perioperative Care and Operating Room ManagementCitation Excerpt :A review article from the United Kingdom suggested that there is not sufficient evidence to routinely discontinue OCPs or HRT, but that the risks of continuing therapy are still undefined.22 A consensus statement by the Society for Perioperative Assessment and Quality Improvement (SPAQI) acknowledges that manufacturer package inserts for both oral contraception and hormone replacement therapy recommend discontinuation for four weeks prior to major surgery. 23 However, given the paucity of data on the risk of postoperative VTE with estrogens and the potential risk of interruption, their consensus recommendation is to “continue estrogens both before and on the day of surgery, but consider potential for increased risk of VTE if continued and pregnancy risk if withheld (if taken for contraception)”.
Practice-Changing Updates in Perioperative Medicine Literature 2020-2021: A Systematic Review
2022, American Journal of MedicineCitation Excerpt :Two reviewers screened each abstract utilizing the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ont, Canada). A modified Delphi process was used to identify 9 articles for full summaries and 13 articles for tabular summaries (Table, 2, 24-35 Figure). Many societies recognize the prognostic importance of MINS; however, they differ in terms of which patients should undergo routine troponin monitoring.2
Preoperative Management of Cardiovascular Medications: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement
2022, Mayo Clinic ProceedingsCitation Excerpt :A modified Delphi process was used to obtain input from a group of experts in anesthesiology and internal medicine who specialize in perioperative medicine.14 We used the same methodology as described in previous SPAQI consensus statements12,15-18 and are explained in detail in Supplemental Appendix (available online at http://www.mayoclinicproceedings.org). An overriding theme during the process was the principle of “first do no harm.”
Preoperative Management of Gastrointestinal and Pulmonary Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement
2021, Mayo Clinic ProceedingsCitation Excerpt :They are less likely than prostacyclin analogues to cause a pulmonary hypertensive crisis with interruption, but they should be continued because of the importance of adequately treated PH. Consensus Recommendations: Continue PDE-5 inhibitors up to and including the day of surgery when used for treatment of PH. Perioperative management of PDE-5 inhibitors prescribed for urologic indications is detailed in another publication within this consensus statement series.3 Riociguat is an oral PH medication that works by stimulating soluble guanylate cyclase, which induces vasodilation in vascular smooth muscle and assists in reducing elevated pulmonary pressure.
Glucagon-like peptide-1 receptor agonists in the perioperative period: Implications for the anaesthesiologist
2024, European Journal of Anaesthesiology
Potential Competing Interests: The authors report no competing interests.