Preoperative evaluation and management consensus recommendations for common cardiovascular drugs

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Cardiovascular diseases such as high blood pressure, arrhythmias, and heart failure are common
in patients with surgical or other surgical anesthesia.
Recently, the Society for Perioperative Evaluation and Quality Improvement (SPAQI) issued a consensus statement on the preoperative management of cardiovascular drugs, which mainly provides guidance and recommendations for the evaluation and management of common cardiovascular drugs before surgery, focusing on the treatment of hypertension, arrhythmia, heart failure, and ischemic heart disease
.

Consensus recommendations for preoperative management of cardiac medications

➤ α-adrenaline blockers (α-blockers)

Drugs: doxazosin, phenoxybenzamine, prazosin, terazosin

Consensus recommendation: Continue to use on the morning of the operation

Other considerations: Ensure adequate hydration, as orthostatic hypotension may occur with prolonged fasting

➤ Angiotensin-converting enzyme inhibitors

Drugs: benazepril, captopril, enalapril, fasinopril, lisinopril, moxipril, quinapril, and ramipril

Consensus recommendation: Discontinue the morning of surgery

Other considerations: Continued use may be considered for low-risk, minimally invasive sedation surgery, or local anesthesia

➤Angiotensin-II receptor blocker

Drugs: azisartan, candesartan, iprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan

Consensus recommendation: Discontinue the morning of surgery

Other considerations: Continued use may be considered for low-risk, minimally invasive sedation surgery, or local anesthesia

➤ Angiotensin receptor - kekeratin inhibitor

Drug: sakubaqu / valsartan

Consensus recommendation: Discontinue the morning of surgery

Other considerations: Cardiology is considered in patients with severe heart failure who have a decrease in ejection fraction

➤ β-receptor blocker

Drugs: atenolol, bisoprolol, carvedilol, metoprolol, propranolol, sotalol

Consensus recommendation: Continue to use on the morning of the operation

➤ Calcium channel blockers

Drugs: amlodipine , diltiazem, felodipine, nifedipine

Consensus recommendation: Continue to use on the morning of the operation

➤ Central action sympathetic blocking drugs

Drugs: clonidine, guanidine, guanfaxine

Consensus recommendation: Continue to use on the morning of the operation

➤ Direct action vasodilators

Drug: hydralazine

Consensus recommendation: Continue to use on the morning of the operation

➤ Loop diuretics

Drugs: bumetanil, furosemide, torrasemide

Consensus recommendation: Discontinue the morning of surgery

Other considerations: Consider continuing use in patients at risk of volume overload or for low-risk procedures with minor sedation or local anesthesia (eg, cataracts).

➤ Thiazide diuretics

Drugs: chlorothione, hydrochlorothiazide, indapamide, metolazone

Consensus recommendation: Continue to use on the morning of the operation

➤ Potassium-sparing diuretics

Drugs: eplerenone, spironolactone, triamterene

Consensus recommendation: Continue to use on the morning of the operation

Other considerations: Evaluate the condition of the liquid before deciding to discontinue or continue use

➤ Endothelin receptor antagonist

Drugs: ambesantam, bosentan, masitetant

Consensus recommendation: Continue to use on the morning of the operation

➤ Cardiac glycosides

Drug: digoxin

Consensus recommendation: Continue to use on the morning of the operation

➤ Nitrovasodilator

Drugs: isosorbide nitrate, isosorbide mononitrate, nitroglycerin

Consensus recommendation: Continue to use on the morning of the operation

Other considerations: If there is recent angina or increased use of nitroglycerin, surgery should be postponed

➤ Phosphodiesterase-5 inhibitors

Drugs: Afanafil, sildenafil, tadalafil, vardinavi

The consensus recommends that if used for the treatment of pulmonary hypertension, it should be continued on the morning of the operation, and in other cases, it should be discontinued 24 hours before surgery

➤Class III antiarrhythmic drugs (potassium channel blockers)

Drugs: amiodarone, dofetilide, dinedarone, sotalol

Consensus recommendation: Continue to use on the morning of the operation

Other precautions: minimize other drugs that prolong the QT interval, closely monitor the ECG and magnesium and potassium levels; Negative inotropic effects may occur, even less so with halogenated inhaled anesthetics

➤ Potassium channel opener

Drug: minoxidil

Consensus recommendation: Continue to use on the morning of the operation

➤ Renin inhibitors

Drug: Aliskiren

Consensus recommendation: Discontinue the morning of surgery

➤Class I antiarrhythmics (sodium channel blockers)

Drugs: Class: disopyramide, procainamide, quinicidine; Class Ib: lidocaine, mexitrol; Ic: flecainide, propafenone, tocainide

Consensus recommendation: Continue to use on the morning of the operation

➤ Sodium channel blocker (late sodium current)

Drug: ranoxine

Consensus recommendation: Continue to use on the morning of the operation

➤Sodium-glucose synergistic transporter-2 inhibitor (SGLT2i)

Drugs: dapagliflozin, empagliflozin, capagliflozin, elogliflozin

The consensus recommended: whether diagnosed with diabetes or not, discontinue dapagliflozin, empagliflozin and capagliflozin 3 days before surgery; Apagliflozin was discontinued 4 days before surgery
.

➤ For the most silencing or local anesthesia procedures with low-risk, minimally invasive, and physiologically significant hemodynamic changes, patients are advised to continue using all conventional cardiovascular drugs, including ACE inhibitors/angiotensin-II receptor blockers
.

Sahai SK, Balonov K, Bentov N, et al.
Preoperative Management of Cardiovascular Medications: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement.
Mayo Clin Proc.
2022 Sep; 97(9):1734-1751.
doi: 10.
1016/j.
mayocp.
2022.
03.
039.