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Perioperative Management of Medications: Additional Guidelines

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NEJM Journal Watch

Allan S. Brett, MD, reviewing Pfeifer KJ et al. Mayo Clin Proc 2021 Dec Oprea AD et al. Mayo Clin Proc 2022 Feb Oprea AD et al. Mayo Clin Proc 2022 Feb

During 2021 and 2022, a multidisciplinary group has issued consensus statements on perioperative management of drugs commonly used in pulmonary, gastroenterology, neurology, psychiatry, and rheumatology practice.

Sponsoring Organization: Society for Perioperative Assessment and Quality Improvement (SPAQI)

Background

The SPAQI has issued several “medication management consensus statements” in 2021 and 2022. Each statement provides a comprehensive overview of commonly prescribed medications (grouped by specialty) and makes recommendations on whether to continue or hold those drugs — both during the days prior to surgery and on the day of surgery. The statements can be accessed through the SPAQI website. opens in new tab and in Mayo Clinic Proceedings. In 2021, NEJM Journal Watch covered the statement on endocrine and urologic medications (NEJM JW Gen Med Aug 1 2021 and Mayo Clin Proc 2021; 96:1655). Now, we provide a snapshot of subsequent statements, published between December 2021 and August 2022

Content of the Consensus Statements

The most recent statements cover the following specialties and drug categories.

  • Pulmonary: Medications for asthma, chronic obstructive pulmonary disease, pulmonary hypertension, and pulmonary fibrosis
  • Gastroenterology: Acid-suppressive agents, antiemetic agents, antiviral agents for hepatitis, anticholinergic and antispasmodic agents, immunomodulators (e.g., for inflammatory bowel disease) and weight-loss drugs
  • Psychiatry: Antianxiety, antidepressant, and antipsychotic drugs, as well as mood-stabilizing drugs and medications for attention-deficit/hyperactivity disorder
  • Neurology: Drugs for multiple sclerosis, myasthenia gravis, Parkinson disease, Alzheimer disease, and seizure disorders
  • Rheumatology: Immunosuppressive drugs and nonsteroidal anti-inflammatory drugs
  • HIV: Antiretroviral drugs

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