| Institution: | 1. Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX;2. Department of Anesthesiology and Perioperative Medicine, Tufts University School of Medicine, Boston, MA;3. Department of Family Medicine, University of Washington, Seattle, WA;4. Division of General Internal Medicine, Mayo Clinic, Rochester, MN;5. Department of Anesthesia, Parkview Ortho Hospital, Fort Wayne, IN;6. Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH;7. Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX;8. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA;9. Department of Anesthesiology, Yale School of Medicine, New Haven, CT;10. University of Virginia School of Medicine, Charlottesville, VAkInova Health Systems, Falls Church, VA;11. Inova Health Systems, Falls Church, VA;12. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA;1. Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN;2. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN;3. Division of Clinical Microbiology, Mayo Clinic, Rochester, MN;1. Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH;2. Departments of Radiology and Medicine, Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL;2. Advisor to residents and Consultant in Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL;1. Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China;2. Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden |
| Abstract: | Cardiovascular conditions such as hypertension, arrhythmias, and heart failure are common in patients undergoing anesthesia for surgical or other procedures. Numerous guidelines from various specialty societies offer variable recommendations for the perioperative management of these medications. The Society for Perioperative Assessment and Quality Improvement identified a need to provide multidisciplinary evidence-based recommendations for preoperative medication management. The society convened a group of 13 members with expertise in perioperative medicine and training in anesthesiology or internal medicine. The aim of this consensus effort is to provide perioperative clinicians with guidance on the management of cardiovascular medications commonly encountered during the preoperative evaluation. We used a modified Delphi process to establish consensus. Twenty-one classes of medications were identified: α-adrenergic receptor antagonists, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, angiotensin receptor–neprilysin inhibitors, β-adrenoceptor blockers, calcium-channel blockers, centrally acting sympatholytic medications, direct-acting vasodilators, loop diuretics, thiazide diuretics, potassium-sparing diuretics, endothelin receptor antagonists, cardiac glycosides, nitrodilators, phosphodiesterase-5 inhibitors, class III antiarrhythmic agents, potassium-channel openers, renin inhibitors, class I antiarrhythmic agents, sodium-channel blockers, and sodium glucose cotransportor-2 inhibitors. We provide recommendations for the management of these medications preoperatively. |
