ABSTRACT

Background: This review article discusses the pharmacodynamic effects of the most commonly used chronic medications by patients undergoing elective surgical procedures, namely cardiovascular drugs (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics, etc.), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs). In addition, the potential adverse drug-interactions between these chronic medications and commonly used anesthetic drugs during the perioperative period will be reviewed. Finally, recommendations regarding the management of chronic medications during the preoperative period will be provided.

Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: “chronic medications in the perioperative period”, and “chronic medications and anesthetic implications.” In addition, we searched for anesthetic side effects associated with the major drug groups.

Results and Conclusions: An understanding of the pharmacodynamic effects of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also affect the morbidity, mortality, recovery time of surgical patients and acute relapse of chronic illnesses which could lead to last minute cancellation of surgical procedures. Part II of this two-part review article focuses on the reported interactions between most commonly taken chronic medications by surgical patients and anesthetic and analgesic drugs, as well as recommendations regarding the handling these chronic medications during the perioperative period. 

摘要

背景：此外，还将审查围手术期这些慢性药物与常用麻醉药物之间潜在的不良药物相互作用。最后，将提供有关术前长期药物管理的建议。

材料和方法：从 2000 年 1 月到 2021 年 2 月，使用以下搜索词/关键字通过 PubMed 和 Google Scholar 在 Medline 数据库中进行了在线搜索：“围手术期的慢性药物”和“慢性药物和麻醉影响”。此外，我们还搜索了与主要药物组相关的麻醉剂副作用。

结果和结论：了解大多数使用的慢性药物的药效学作用对于避免围手术期的不良后果很重要。这些药物相互作用可能会导致手术期间施用的麻醉药物的功效和毒性发生改变。这些药物相互作用还会影响手术患者的发病率、死亡率、恢复时间和慢性疾病的急性复发，这可能导致最后一刻取消手术程序。这篇由两部分组成的评论文章的第二部分重点介绍了手术患者最常服用的慢性药物与麻醉和镇痛药物之间的相互作用，以及有关在围手术期处理这些慢性药物的建议。