Antiarrhythmics (e.g., Amiodarone, Sotalol, Ibutilide)

Affect tolerance of anesthesia and potentiate neuromuscular blockers.

Depress cardiac function, output, and pulse.

• Obtain baseline ECG.
• Communicate abnormal findings to anesthesia.

Antihypertensives (e.g., Metoprolol, Atenolol, Losartan)

Alter response to muscle relaxants and opioids.

May cause hypotensive crisis during and after surgery.

• Obtain baseline BP and HR.
• Communicate abnormal findings to anesthesia.

Corticosteroids (e.g., Dexamethasone, Hydrocortisone, Prednisone)

Surgery increases need for higher steroid doses in Pts who are currently using steroids for replacement therapy.

May increase healing time due to blockage of collagen formation.

Increases risk of hemorrhage and may mask signs of infection.

• Steroid therapy is continued during surgery (IV route if NPO).
• Assess for hyperglycemia, infection, bleeding, and wound healing.
• Splint incisions to promote healing.

Anticoagulants/NSAIDs (e.g., Warfarin, Heparin, Ibuprofen, Aspirin)

May prolong bleeding time and cause intra- or post-op bleeding.

• Obtain baseline coagulation studies.
• Depending on medication and lab results (e.g., PT INR), medication may need to be held up to 5–6 days prior to surgery.
• D/C medication prior to surgery (selected examples below).
• Warfarin D/C 5–6 days (and PT INR <1.3).
• Dabigatran D/C 1–2 days (3–5 days CCr <50 mL/min).
• Rivaroxaban D/C 24 hr.
• Apixaban D/C 24-48 hr.
• Edoxaban D/C 24 hr.
• Low-molecular-weight heparin (LMWH) D/C 12–24 hr
• Unfractionated heparin (UHF) D/C 2–6 hr
• Inform surgeon if medication has not been withheld before surgery.
• Have vitamin K (for warfarin) and protamine sulfate (for heparin) available as antidotes for excessive bleeding during surgery.

Anticonvulsants (e.g., Phenobarbital, Phenytoin)

Seizures during surgery can cause injury.

May alter metabolism of anesthesia.

• Anticonvulsant therapy is continued during and after surgery.
• Have suction and oral airway available.

Insulin (e.g., regular, Humalog, Humulin, Novolog, Novolin, Lantus)

Pt requires less insulin during pre-op period due to fasting; may require more post-op due to stress of surgery increasing glucose release; needs may fluctuate post-op because of decreased oral intake.

• Closely monitor blood glucose levels pre/intra/postoperatively.