On the day of surgery we can give which drug’s when pt is npo ?
Reading File
Finding Sources
Finding Sources
Searching the Web
drugs to continue on day of surgery NPO patient anesthesia guidelines 2024
Finding Sources
Finding Sources
Finding Sources
Reading Web Page
https://www.froedtert.com/sites/default/files/upload/docs/pr…
Reading File
I now have comprehensive information from Miller's Anesthesia and clinical guidelines. Here is a detailed answer:
Drugs to CONTINUE on Day of Surgery (NPO Patient)
The key principle is: take with a small sip of water (15-30 mL). The goal is to avoid rebound effects, hemodynamic instability, or withdrawal while the patient is fasting.
✅ CONTINUE (Give on the Morning of Surgery)
| Drug Class | Examples | Reason |
|---|---|---|
| Beta-blockers | Metoprolol, atenolol, carvedilol | Prevent rebound tachycardia/hypertension; abrupt withdrawal can trigger MI |
| Calcium channel blockers | Amlodipine, diltiazem, verapamil | Hemodynamic stability |
| Alpha-2 agonists | Clonidine, methyldopa | Avoid rebound hypertensive crisis |
| Alpha-1 blockers | Tamsulosin, doxazosin | Hemodynamic stability |
| Antiarrhythmics | Amiodarone, digoxin, sotalol | Continuous rhythm control needed |
| Nitrates/Vasodilators | Nitroglycerin, isosorbide, hydralazine | Cardiac protection |
| Statins | Atorvastatin, rosuvastatin | Pleiotropic cardioprotective effect; abrupt withdrawal harmful |
| Aspirin (cardiac indications) | Low-dose aspirin | Continue if history of CAD/stents; stop only for neuro/ophthalmic/spine surgery |
| Antiepileptics (AEDs) | Levetiracetam, valproate, phenytoin | Prevent perioperative seizures; IV alternatives available |
| Antiparkinson drugs | Levodopa/carbidopa, entacapone | Abrupt withdrawal risks NMS-like syndrome; give up to time of surgery |
| Antipsychotics | Haloperidol, risperidone, olanzapine | Prevent psychosis and agitation postop |
| Anxiolytics/Benzodiazepines | Alprazolam, clonazepam, lorazepam | Prevents anxiety and withdrawal; also used as premeds |
| Inhaled bronchodilators | Salbutamol, ipratropium, tiotropium, salmeterol | Reduces perioperative bronchospasm and pulmonary complications |
| Inhaled corticosteroids | Fluticasone, budesonide | Reduces airway reactivity |
| Systemic steroids | Prednisolone | Avoid adrenal insufficiency; give stress-dose steroids if on long-term use |
| Thyroid medications | Levothyroxine | Long half-life (7 days), but continue for stability |
| Antiretrovirals | Tenofovir, efavirenz, lamivudine | Resistance develops quickly with missed doses |
| Antivirals | Acyclovir, valacyclovir | Continue for immunosuppressed patients |
| Long-acting opioids | MS Contin, oxycontin (in chronic pain patients) | Prevent acute withdrawal; for major surgery, convert to IV background infusion if NPO >8 hrs (Miller's Anesthesia, 10e, Box 47.2) |
| Ophthalmic drops | Pilocarpine, timolol eye drops | Continue (absorbed minimally, topical use) |
| Immunosuppressants | Tacrolimus, cyclosporine (transplant patients) | Transplant rejection risk; check levels |
| Non-biologic DMARDs | Methotrexate, hydroxychloroquine, sulfasalazine | Generally continue (rheumatoid arthritis, IBD) |
❌ HOLD / WITHHOLD on Day of Surgery
| Drug Class | Reason |
|---|---|
| ACE inhibitors / ARBs | Risk of refractory intraoperative hypotension; hold morning dose (unless heart failure or uncontrolled HTN) |
| Diuretics (furosemide, HCTZ) | Risk of hypovolemia and hypokalemia |
| Metformin | Risk of lactic acidosis, especially if contrast used or prolonged NPO |
| SGLT-2 inhibitors (empagliflozin, dapagliflozin) | Risk of euglycemic DKA; hold 3-4 days before |
| Insulin | Adjust - give reduced dose (50-75% of basal); hold prandial doses |
| Sulfonylureas (glipizide, glibenclamide) | Risk of hypoglycemia while NPO |
| Oral hypoglycemics (most) | Hold; resume when eating |
| NSAIDs | Typically hold 24-72 hrs preop (bleeding risk, AKI risk) |
| Biologic DMARDs (adalimumab, etanercept, infliximab) | Infection risk, impaired wound healing; hold for one dosing cycle |
| JAK inhibitors (tofacitinib, baricitinib) | Hold ≥3 days prior |
| Oral anticoagulants (warfarin, rivaroxaban, apixaban, dabigatran) | Bleeding risk; managed per bridging protocols |
| MAOIs | Drug interactions with anesthetics; consult anesthesia |
| GLP-1 agonists (semaglutide, liraglutide) | Delayed gastric emptying, increased aspiration risk; hold 1 week prior |
| Estrogen/HRT | Thromboembolism risk; stop ~4 weeks before major surgery |
| Bisphosphonates | Routinely held day of surgery |
Special Notes
- Insulin: Never hold completely in Type 1 DM. Give 50-75% of basal insulin; hold all prandial (bolus) doses. Monitor glucose every 1-2 hours.
- Steroids: Patients on long-term steroids (>5 mg prednisolone/day for >3 weeks) need stress-dose hydrocortisone (50-100 mg IV) to prevent adrenal crisis.
- Antiparkinson drugs: Critical to give right up to surgery. Even a few missed doses can cause neuroleptic malignant syndrome-like withdrawal. (Perioperative Medication Management, VMFH)
- All oral medications on the day of surgery should be given with a sip of water (≤30 mL) - this does NOT violate NPO status. (Miller's Anesthesia, 10e)
Memory aid (CONTINUE = "BASS CAB + Steroids + AEDs + Parkinson"):
- B - Beta-blockers
- A - Antiarrhythmics / Alpha agonists
- S - Statins
- S - Steroids (stress dose)
- C - Calcium channel blockers
- A - Antiepileptics / Antiparkinson
- B - Bronchodilators (inhaled)
What about cilastozol and sodium bicarbonate?
Finding Sources
Finding Sources
Searching the Web
cilostazol hold before surgery perioperative antiplatelet guidelines
Finding Sources
Searching the Web
sodium bicarbonate premedication day of surgery NPO aspiration prophylaxis anesthesia
Finding Sources
Finding Sources
Finding Sources
Finding Sources
I have enough information from the guidelines and textbooks to give a thorough answer. Here it is:
Cilostazol and Sodium Bicarbonate on Day of Surgery
Cilostazol (Pletal) - ❌ HOLD / Do NOT Give on Day of Surgery
What it is: A selective PDE-3 (phosphodiesterase III) inhibitor - acts as a reversible antiplatelet agent and vasodilator. Used for peripheral arterial disease (intermittent claudication) and stroke prevention. (Sabiston Textbook of Surgery)
Perioperative management:
| Guideline Source | Recommendation |
|---|---|
| Froedtert / Most US guidelines | Hold at least 5 days before surgery |
| NHS Scotland / UK guidelines | Hold 7 days before surgery |
| Chesapeake Regional guidelines | Hold 4 days preop |
| UKCPA Handbook | Manufacturer recommends 5-day cessation; for ophthalmology, 3 days may be sufficient (t½ = 10.5-13 hrs) |
Why hold it?
- Reversible antiplatelet activity - increases bleeding risk
- For neuraxial anesthesia (spinal/epidural): cilostazol must be stopped minimum 2 days before catheter insertion; next dose can only be given ≥5 hours after block or catheter removal
- Claudication symptoms may temporarily return when stopped, but will respond once restarted post-op
Bottom line: Cilostazol is NOT given on the day of surgery. It should have been stopped 5-7 days before.
Sodium Bicarbonate - ✅ GIVEN on Day of Surgery (as a Premedication)
What it is: A non-particulate antacid. It is NOT the patient's regular medication - rather, it is deliberately administered on the day of surgery as part of aspiration prophylaxis.
Why it is given preoperatively:
- Neutralizes gastric acid, raising gastric pH to >2.5
- Reduces the severity of Mendelson's syndrome (aspiration pneumonitis) if aspiration occurs
- It is a clear liquid - does not increase gastric volume and does not violate NPO rules
When is it used?
- Patients at high risk of aspiration - full stomach, emergency surgery, obstetric patients, morbid obesity, GERD, hiatus hernia, gastroparesis, difficult airway
- Given orally 15-30 minutes before induction of anesthesia
Sodium bicarbonate vs Sodium citrate:
- The more commonly used preparation is 0.3M sodium citrate (Bicitra/Citrotein) - but sodium bicarbonate solution serves the same purpose
- Both are non-particulate antacids and are safe to give despite NPO status because they are clear liquids that actually protect against aspiration pneumonitis
Standard aspiration prophylaxis regimen (commonly used together):
- Sodium bicarbonate / sodium citrate (30 mL orally) - 15-30 min preop
- Ranitidine or Omeprazole (H2 blocker / PPI) - given night before + morning of surgery
- Metoclopramide - prokinetic, empties stomach, raises LES tone
Bottom line: Sodium bicarbonate is GIVEN on the day of surgery - it is a premedication for aspiration prophylaxis, not a regular drug that gets "continued." It does not violate NPO guidelines since it is a clear liquid antacid.
Calprotectin and pro calcitonin
Reading File
Finding Sources
Finding Sources
Reading File
Finding Sources
Reading File
Finding Sources
Reading File
Finding Sources
Your credits are exhausted. You can purchase a top-up or subscribe to a plan to continue using Orris. If you're already subscribed, your daily credits will reset tomorrow.
Create a comparison poster: Calprotectin vs Procalcitonin
Your credits are exhausted. You can purchase a top-up or subscribe to a plan to continue using Orris. If you're already subscribed, your daily credits will reset tomorrow.
This is a shared conversation. Sign in to Orris to start your own chat.