1.7 Medication related to history and its impact on anesthesia and surgery

Okay, so if a person is already taking some medications, we need to know about those.

Lets take this step by step.

We have some drugs that should be continued until the day of the surgery or the day before. The mnemonic for this is 'And Always At Birthdays, Cake Gets Served'.

1. And: Antipsychotics, antiepileptics, antianxiety, antidepressants drugs: they should be taken until the morning of the surgery.
2. Always: Alzheimers medications should be continued until the last evening. One note with Parkinson's medications is that they should be discontinued longer than other medications in case the procedure is Deep Brain stimulation, because that makes sense.
3. At: anti-hypertensives like beta blockers are fine.
4. Birthdays: birth control pills should be discontinued weeks before surgery because of a high risk of thrombo-embolism.
5. Cake: corticosteroids should be continued until the morning of the surgery.
6. Gets: gastric medication should be continued until the morning of the surgery.
7. Served: statins and systesis drugs (like thyroxine) should also be continued until the morning of the surgery. For insulin, the protocol is very specific.

Next are the drugs that should be discontinued which can be remembered by the following mnemonic: DAMB (combination of DAMP and DUMP??)

1. D: diuretics should be discontinued
2. A: ACE inhibitors and ARBs should be discontinued before surgery.
3. M: metformin should be stopped 24 hours before surgery. Can cause glycemia.
4. B: bisphosphonates for bones should be stopped as well until 24 hours before.

Now, because a surgery is being performed, there will be bleeding so we need to be careful with anticoagulants.