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This article comes from the NEJM Journal Watch (NEJM Journal Watch) Perioperative Management of Endocrine and Urologic Medications Perioperative Management of Endocrine and Urologic Medications.
Author: Allan S.
Brett, MD The multidisciplinary expert group has released on which drugs to continue before surgery Medication, recommendations on which medications will be suspended
.
Organizer: Society for Perioperative Assessment and Quality Improvement (SPAQI)
.
Background SPAQI is a multidisciplinary organization that has recently published several position papers on perioperative drug management
.
This statement on endocrine and urinary system medications is made in accordance with the consensus procedure outlined by the author
.
Key recommendations for diabetes treatment drugs: basic (medium-acting or long-acting) insulin should usually be continued on the morning of the operation or the night before the operation at 60% to 80% of the conventional dose, depending on the patient’s conventional insulin regimen; metformin, sulfonate Urea, pioglitazone, and dipeptidyl peptidase (DPP)-4 inhibitors should not be administered on the morning of surgery; sodium-glucose cotransporter (SGLT)-2 inhibitors should be discontinued at least 3 days before surgery; pancreatic height Glucagon-like peptide (GLP)-1 agonists should be suspended on the morning of surgery (drugs administered daily) or 1 week before surgery (drugs administered weekly)
.
Other endocrine system medications: Thyroid hormones and antithyroid drugs can be administered in the morning of the operation; patients can receive regular doses of corticosteroids in the morning of the operation (this document does not involve perioperative medication with additional "stress dose" steroids); Most other hormones or endocrine-related drugs can be continued on the morning of the operation
.
However, the use of bisphosphonates should be suspended (the reason is that if the patient lies on his back after taking these drugs, there is a risk of esophagitis)
.
Urinary system medication: α-receptor blockers and 5-α-reductase inhibitors can be administered on the morning of surgery; anticholinergic drugs for the treatment of bladder disease should be suspended on the morning of surgery; used to treat urinary system adaptation At the time of syndrome, phosphodiesterase (PDE)-5 inhibitors should be suspended for 3 days before surgery because of concerns about intraoperative hypotension
.
Most of these suggestions are based on common sense inferences based on the drug's mechanism of action and side effects, rather than based on preoperative research
.
The author encourages making clinical judgments in certain situations (for example, for patients with high risk of perioperative thrombosis, suspending certain hormone drugs that promote thrombosis)
.
I urge clinicians responsible for preoperative evaluation to read this document
.
Commented article Pfeifer KJ et al.
Preoperative management of endocrine, hormonal, and urologic medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement.
Mayo Clin Proc 2021 Jun; 96:1655.
(https://doi.
org /10.
1016/j.
mayocp.
2020.
10.
002) NEJM Journal Watch is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments
.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat
.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM)
.
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group
.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities
.
Author: Allan S.
Brett, MD The multidisciplinary expert group has released on which drugs to continue before surgery Medication, recommendations on which medications will be suspended
.
Organizer: Society for Perioperative Assessment and Quality Improvement (SPAQI)
.
Background SPAQI is a multidisciplinary organization that has recently published several position papers on perioperative drug management
.
This statement on endocrine and urinary system medications is made in accordance with the consensus procedure outlined by the author
.
Key recommendations for diabetes treatment drugs: basic (medium-acting or long-acting) insulin should usually be continued on the morning of the operation or the night before the operation at 60% to 80% of the conventional dose, depending on the patient’s conventional insulin regimen; metformin, sulfonate Urea, pioglitazone, and dipeptidyl peptidase (DPP)-4 inhibitors should not be administered on the morning of surgery; sodium-glucose cotransporter (SGLT)-2 inhibitors should be discontinued at least 3 days before surgery; pancreatic height Glucagon-like peptide (GLP)-1 agonists should be suspended on the morning of surgery (drugs administered daily) or 1 week before surgery (drugs administered weekly)
.
Other endocrine system medications: Thyroid hormones and antithyroid drugs can be administered in the morning of the operation; patients can receive regular doses of corticosteroids in the morning of the operation (this document does not involve perioperative medication with additional "stress dose" steroids); Most other hormones or endocrine-related drugs can be continued on the morning of the operation
.
However, the use of bisphosphonates should be suspended (the reason is that if the patient lies on his back after taking these drugs, there is a risk of esophagitis)
.
Urinary system medication: α-receptor blockers and 5-α-reductase inhibitors can be administered on the morning of surgery; anticholinergic drugs for the treatment of bladder disease should be suspended on the morning of surgery; used to treat urinary system adaptation At the time of syndrome, phosphodiesterase (PDE)-5 inhibitors should be suspended for 3 days before surgery because of concerns about intraoperative hypotension
.
Most of these suggestions are based on common sense inferences based on the drug's mechanism of action and side effects, rather than based on preoperative research
.
The author encourages making clinical judgments in certain situations (for example, for patients with high risk of perioperative thrombosis, suspending certain hormone drugs that promote thrombosis)
.
I urge clinicians responsible for preoperative evaluation to read this document
.
Commented article Pfeifer KJ et al.
Preoperative management of endocrine, hormonal, and urologic medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement.
Mayo Clin Proc 2021 Jun; 96:1655.
(https://doi.
org /10.
1016/j.
mayocp.
2020.
10.
002) NEJM Journal Watch is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments
.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat
.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM)
.
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group
.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities
.
