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    Home > Active Ingredient News > Anesthesia Topics > Rheumatism patients with immunosuppressive drugs undergo surgery, preoperative medication management recommendations at a glance!

    Rheumatism patients with immunosuppressive drugs undergo surgery, preoperative medication management recommendations at a glance!

    • Last Update: 2022-10-03
    • Source: Internet
    • Author: User
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    The increasing complexity of patients undergoing surgery makes perioperative medication management challenging
    .



    In August 2022, the Society for Perioperative Assessment and Quality Improvement (SPAQI) published a consensus statement
    on the preoperative management of drugs for rheumatology and AIDS treatment.



    1.


    Preoperative advice: Continue to use before surgery, including on the day of surgery

    Other considerations: the drug can affect multiple organ systems (eg, heart, kidneys, lungs, liver, hematologic system); Fluctuations in renal function may produce toxic reactions

    Adjunctive tests: complete blood count (CBC), creatinine, and liver function tests (LFTs)


    2.


    Preoperative advice: Continue to use before surgery, including on the day of surgery

    Other considerations: may reduce the white blood cell count

    Auxiliary tests: CBC


    3.


    Preoperative advice: Continue to use before surgery, including on the day of surgery

    Other considerations: can lead to prolongation of the QT interval, hypoglycemia, pancytopenia

    Auxiliary tests: CBC, electrocardiogram (ECG)


    4.


    Preoperative advice: discontinue 4 weeks before surgery

    Other considerations: may lead to increased risk of infection, bone marrow suppression, cardiac and bladder toxic effects, syndrome of improper secretion of antidiuretic hormone (SIADH)

    Auxiliary tests: CBC, electrolytes, urinalysis


    5.


    Preoperative advice: Continue to use before surgery, including on the day of surgery

    Other considerations: associated with hyperglycemia and an increased risk of infection; Long-term use is associated with increased postoperative complications (including infection), therefore, preoperative should be reduced to the lowest dose as possible

    Ancillary test: rapid blood glucose test


    6.
    Apost

    Preoperative advice: Continue to use before surgery, including on the day of surgery

    Other considerations: can cause headache, dizziness, diarrhea, nausea/vomiting


    7.
    Sulfasalazine

    Preoperative advice: Continue to use before surgery, including on the day of surgery

    Other considerations: in combination with NSAIDs increases the risk of bleeding

    Adjunctive tests: CBC, LFTs, creatinine


    8.
    Leflunomide

    Preoperative advice: Continue to use before surgery, including on the day of surgery

    Other considerations: can cause respiratory infections, headaches, rashes and liver enzyme abnormalities; There is an interaction with several oral hypoglycemic drugs, which increases the risk of hypoglycemia

    Auxiliary tests: CBC, LFTs,


    9.
    Mycophenolate mofetil

    Preoperative recommendations:

    ➤ Severe systemic lupus erythematosus (SLE) – continued preoperatively, including on the day of surgery

    ➤ Non-severe SLE – discontinued 7 days before surgery

    Other considerations: toxic effects may occur if renal function declines postoperatively

    Adjunctive tests: CBC, electrolytes, and creatinine


    10.
    Azoprine

    Preoperative recommendations:

    ➤ Severe SLE — Continue to use before surgery, including on the day of surgery

    ➤ Non-severe SLE – discontinued 7 days before surgery

    Other considerations: 3-5 days after surgery, as long as there are no wound healing or infection problems at the surgical site or other sites, you can start using again

    Adjunctive tests: CBC, LFTs, and creatinine


    11.
    Cyclosporine

    Preoperative recommendations:

    ➤ Severe SLE — Continue to use before surgery, including on the day of surgery

    ➤ Non-severe SLE – discontinued 7 days before surgery

    Other considerations: neurotoxic effects (paresthesias, delirium, seizures) and nephrotoxic effects; Multiple drug-drug interactions with inhibition/induction of CYP34A drugs, many of which are used in the perioperative period, requiring close monitoring of cyclosporine levels; 3-5 days after surgery, as long as there are no wound healing or infection problems at the surgical site or other areas, you can start using again

    Auxiliary tests: CBC, electrolytes, magnesium, glucose levels and creatinine


    12.
    Tacrolimus

    Preoperative recommendations:

    ➤ Severe SLE — Continue to use before surgery, including on the day of surgery

    ➤ Non-severe SLE – discontinued 7 days before surgery

    Other considerations: can lead to nephrotoxic and neurotoxic effects, prolongation of the QT interval, new diabetes mellitus, as well as pure red blood cell aplasia; The presence of multiple drug-drug interactions with inhibition/induction of CYP34A drugs, many of which are used in the perioperative period, requires close monitoring of tacrolimus levels; 3-5 days after surgery, as long as there are no wound healing or infection problems at the surgical site or other areas, you can start using again

    Auxiliary tests: ECG, CBC, electrolytes, magnesium, glucose levels and creatinine


    13.
    Voclosporin

    Preoperative advice: continue to apply according to the treatment cycle, and arrange surgery at the end of the treatment cycle

    Other considerations: can lead to nephrotoxic and neurotoxic effects, prolongation of the QT interval, hypertension; There are multiple drug-drug interactions with inhibition/induction of CYP34A drugs

    Auxiliary tests: ECG, CBC, electrolytes, magnesium and creatinine


    Oprea AD, Keshock MC, et al.
    Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement.
    Mayo Clin Proc.
    2022 Feb; 97(2):397-416.
    doi: 10.
    1016/j.
    mayocp.
    2021.
    11.
    011.
    PMID: 35120702.

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