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Medicine Management Before Surgery

AMBULATORY CARE:

Medicine management before surgery

means creating a plan with your healthcare providers to stop, start, or change your medicines. The plan can help prevent complications during and after surgery. The plan may also prevent your surgery from getting canceled or delayed.

How to create a medicine management plan:

  • Tell all of your healthcare providers about your surgery. Schedule appointments to see them before your surgery. You may need blood work or tests before surgery to help your healthcare provider make changes to your medicines. Some of your medicines may need to be stopped several days to weeks before surgery. Other medicines may be stopped the night before, or need to be taken the day of surgery. Do not stop taking your medicine until you talk to your healthcare providers.
  • Bring a list of all of your medicines, vitamins, and dietary supplements to your preoperative appointment and on the day of surgery. You may also bring your pill bottles. This will help your anesthesiologist plan your anesthesia and keep you safe during and after surgery.
  • If your healthcare provider tells you to take medicine on the day of surgery, take it in the morning with a sip of water. On the day of your surgery, tell healthcare providers what medicines you did or did not take that day.

Contact your healthcare provider if:

  • You have questions about when to stop taking your medicine before surgery.
  • You have questions about what medicines to take or not take on the day of your surgery.
  • You need a prescription refilled before surgery.

Blood thinner and antiplatelet medicine:

If you take blood thinners or antiplatelet medicines, you may be at risk for heavy bleeding during or after surgery. Ask your healthcare provider if you need to stop taking your medicine, and when to stop. After you have stopped your medicine for several days, you may need blood tests. Your surgery may be canceled or rescheduled if your blood tests are abnormal.

  • You may need to stop taking your blood thinner, such as warfarin, 5 to 7 days before your surgery. While you are not taking your blood thinner, you may need daily injections of heparin. Heparin may decrease your risk for a blood clot while you are not taking your blood thinner. You may need heparin injections once per day, starting the day that you stop your blood thinner. You may continue heparin injections until the day of your surgery. Talk to your healthcare provider about heparin injections. You may need a family member or friend to give you the heparin injection.
  • New oral anticoagulants (NOAC), such as rivaroxaban, may be stopped closer to the day of your surgery. Your healthcare provider may tell you to stop your NOAC 1 to 3 days before surgery. You will not need heparin injections or other medicines while you are not taking your NOAC. Talk to your healthcare provider before you stop taking your NOAC.
  • Your healthcare provider may tell you to stop taking antiplatelet medicine, such as aspirin, 5 to 7 days before surgery. You may instead need to continue taking your medicine until the day of your surgery. Talk to your healthcare provider about when to stop these medicines.

Heart medicine:

Take your heart medicine on the day of your surgery unless your healthcare provider tells you not to. Heart medicines may decrease your risk for complications during or after surgery. If you have had a heart attack or chest pain during exercise, you may need to see a cardiologist before surgery. You may also need to see a cardiologist if you have coronary artery disease. The cardiologist may change your medicines or start you on a heart medicine called a beta-blocker. A beta-blocker controls your heart rate, and may decrease your risk for heart problems during or after surgery.

Blood pressure medicine:

  • Take your blood pressure medicine on the day of surgery unless your healthcare provider tells you not to. Ask if you should take your diuretic, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker (ARB) on the day of surgery. These medicines may need to be stopped 1 to 2 days before surgery. Diuretic medicines may cause your blood pressure to go too low during surgery. If you take more than one blood pressure medicine, ask which medicine to take on the day of your surgery.
  • You may need your blood pressure checked a few days before your surgery. This may help your healthcare provider make changes to your medicine and get you ready for surgery. If your blood pressure is not controlled before your surgery, the surgery may be canceled or delayed.

Diabetes medicine:

  • Keep a diary of your blood sugar levels for 2 weeks before your surgery. Bring your diary to your preoperative appointments. This will help your healthcare providers plan how to change, or when to stop, your diabetes medicine before surgery.
  • Talk to your healthcare provider about managing your diabetes medicine before surgery. You may be told to lower your dose of long-acting or intermediate-acting insulin the night before, or the morning of, your surgery. You may also be told to skip your dose of fast-acting insulin on the morning of your surgery. Do not take your oral diabetes medicine on the day of your surgery unless your healthcare provider says it is okay. Oral diabetes medicine may cause your blood sugar to drop too low during or after surgery.
  • If you use an insulin pump, ask what you should do the night before, and morning of, your surgery. Your healthcare provider may tell you to continue or lower your basal dose, and skip your bolus doses, on the day of surgery. Bring extra supplies for you insulin pump, such as cartridges, tubing, and needles. When you arrive for surgery, tell all healthcare providers that you use an insulin pump. They will need to know how your pump works, what your basal rate is, and how to make changes to your basal rate. Your anesthesiologist may disconnect your insulin pump and use IV insulin instead to control your blood sugars during surgery.
  • Check your blood sugar level on the morning before your surgery. Fasting may cause your blood sugar to be low. The stress of surgery may instead cause your blood sugar to be high. At your preoperative appointment ask your healthcare provider what to do on the morning of surgery if your blood sugar is high or low. Your blood sugar will be monitored closely before, during, and after surgery. This will prevent complications such as poor wound healing and infection.

Antiseizure medicine:

Take your antiseizure medicine on the morning of your surgery unless your healthcare provider tells you not to. Your healthcare provider may give you antiseizure medicine in your IV before or after surgery.

Nonopioid pain medicine:

Stop taking your nonopioid pain medicine 2 days before surgery. Nonopioid pain medicine, such as NSAIDs, may increase your risk for bleeding during surgery. Other nonopioid medicine, such as gabapentin, may interfere with other medicines you may get during surgery.

Steroids:

Take your steroid medicine on the day of your surgery unless your healthcare provider tells you not to. Your healthcare provider may give you an extra, larger dose of IV steroids before or during your surgery to prevent low blood pressure.

Hormones:

Take your thyroid medicine on the morning of your surgery unless your healthcare provider tells you not to. Ask your healthcare provider if you should take other hormone medicines on the day of surgery.

Immunosuppressants:

You may need to stop taking your immunosuppressants several days before, or the night before, your surgery. Immunosuppressants may increase your risk for wound infection and prevent wound healing. Talk to your healthcare provider about when to stop your immunosuppressants.

Diet medicines:

Ask your healthcare provider when to stop taking diet medicine. Some diet medicines need to be stopped several days to weeks before surgery. Diet medicine may prevent other medicines from working or cause complications during surgery.

Vitamins and herbal supplements:

Stop taking herbal supplements 1 week before surgery. Most vitamins can be taken up to the day before surgery. Ask your healthcare provider if you need to stop taking any vitamins before surgery. Some vitamins and herbal supplements may increase your risk for bleeding during surgery. They can also prevent anesthesia medicines from working right or increase your risk for a heart attack or stroke during surgery.

Asthma or medicine for COPD:

Take your inhalers and asthma or COPD medicine on the morning of surgery. Bring your inhalers with you to your surgery.

Anxiety, depression, or psychiatric medicine:

Take your anxiety, depression, or psychiatric medicine on the morning of surgery, unless your healthcare provider tells you not to. Tell your anesthesiologist if you take a monoamine oxidase inhibitor (MAOI), such as phenelzine sulfate. To prevent complications, your anesthesiologist may need to change the type of anesthesia that you will get during surgery.

Other medicines:

Ask your healthcare provider if and when you should stop take any other type of medicine before surgery.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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