Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Related articles

Perioperative medication management

Topic Outline

GRAPHICS

INTRODUCTION

At least 50 percent of patients undergoing surgery take medications on a regular basis [1]. Clinicians often must decide if chronic medications should be continued in the perioperative period. Unfortunately, there are few outcome data about the majority of medications taken in the perioperative period.

This lack of medical evidence is reflected by the large variation in perioperative management recommendations among anesthesiologists [2]. The recommendations in this review are to a large degree expert opinion, based on information from other reviews [3,4] and textbooks, along with clinical experience and theoretic considerations.

This topic will focus on medications known to have perioperative effects, those known to interact with anesthetic agents, and those in common use. An overview of preoperative patient assessment and details about perioperative management for specific medications are presented separately. (See "Overview of the principles of medical consultation and perioperative medicine" and "Perioperative management of hypertension" and "Perioperative management of patients receiving anticoagulants" and "The surgical patient taking glucocorticoids".)

PRINCIPLES OF MEDICATION MANAGEMENT

The following principles inform the management of chronic medications in the perioperative period:

A complete medication history should be obtained, and all clinicians involved in patient management (eg, surgeon, anesthesiologist, medical consultants) should review the medication history. Medication use reported by the patient should be verified (medication reconciliation) to address accuracy of drugs and doses [5]. This should include all over-the-counter and herbal/complementary medications, as well as prescription drugs. In addition, substance use information (including alcohol, nicotine, and illicit drugs) should be elicited.

                                                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2014. | This topic last updated: Jun 2, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Kennedy JM, van Rij AM, Spears GF, et al. Polypharmacy in a general surgical unit and consequences of drug withdrawal. Br J Clin Pharmacol 2000; 49:353.
  2. Kroenke K, Gooby-Toedt D, Jackson JL. Chronic medications in the perioperative period. South Med J 1998; 91:358.
  3. Spell NO 3rd. Stopping and restarting medications in the perioperative period. Med Clin North Am 2001; 85:1117.
  4. Smith MS, Muir H, Hall R. Perioperative management of drug therapy, clinical considerations. Drugs 1996; 51:238.
  5. Clay BJ, Halasyamani L, Stucky ER, et al. Results of a medication reconciliation survey from the 2006 Society of Hospital Medicine national meeting. J Hosp Med 2008; 3:465.
  6. Pass SE, Simpson RW. Discontinuation and reinstitution of medications during the perioperative period. Am J Health Syst Pharm 2004; 61:899.
  7. Shammash JB, Trost JC, Gold JM, et al. Perioperative beta-blocker withdrawal and mortality in vascular surgical patients. Am Heart J 2001; 141:148.
  8. Wallace AW, Au S, Cason BA. Association of the pattern of use of perioperative β-blockade and postoperative mortality. Anesthesiology 2010; 113:794.
  9. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Society of Echocardiography, American Society of Nuclear Cardiology, et al. 2009 ACCF/AHA focused update on perioperative beta blockade. J Am Coll Cardiol 2009; 54:2102.
  10. Hoffman BB. Therapy of hypertension. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 11th ed, Brunton LB, Lazo JS, Parker KL (Eds), McGraw-Hill, New York 2006.
  11. Berggren H, Ekroth R, Herlitz J, et al. Myocardial protective effect of maintained beta-blockade in aorto-coronary bypass surgery. Scand J Thorac Cardiovasc Surg 1983; 17:29.
  12. Pontén J, Biber B, Henriksson BA, et al. beta-Receptor blockade and neurolept anaesthesia. Withdrawal vs continuation of long-term therapy in gall-bladder and carotid artery surgery. Acta Anaesthesiol Scand 1982; 26:576.
  13. Mashour GA, Sharifpour M, Freundlich RE, et al. Perioperative metoprolol and risk of stroke after noncardiac surgery. Anesthesiology 2013; 119:1340.
  14. Ashes C, Judelman S, Wijeysundera DN, et al. Selective β1-antagonism with bisoprolol is associated with fewer postoperative strokes than atenolol or metoprolol: a single-center cohort study of 44,092 consecutive patients. Anesthesiology 2013; 119:777.
  15. Dai N, Xu D, Zhang J, et al. Different β-blockers and initiation time in patients undergoing noncardiac surgery: a meta-analysis. Am J Med Sci 2014; 347:235.
  16. Wallace AW, Au S, Cason BA. Perioperative β-blockade: atenolol is associated with reduced mortality when compared to metoprolol. Anesthesiology 2011; 114:824.
  17. van Lier F, Schouten O, Hoeks SE, et al. Impact of prophylactic beta-blocker therapy to prevent stroke after noncardiac surgery. Am J Cardiol 2010; 105:43.
  18. Stühmeier KD, Mainzer B, Cierpka J, et al. Small, oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology 1996; 85:706.
  19. Oliver MF, Goldman L, Julian DG, Holme I. Effect of mivazerol on perioperative cardiac complications during non-cardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT). Anesthesiology 1999; 91:951.
  20. Wallace AW, Galindez D, Salahieh A, et al. Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology 2004; 101:284.
  21. Devereaux PJ, Sessler DI, Leslie K, et al. Clonidine in patients undergoing noncardiac surgery. N Engl J Med 2014; 370:1504.
  22. Lilja M, Jounela AJ, Juustila H. Withdrawal syndromes and the cessation of antihypertensive therapy. Arch Intern Med 1982; 142:839.
  23. Hart GR, Anderson RJ. Withdrawal syndromes and the cessation of antihypertensive therapy. Arch Intern Med 1981; 141:1125.
  24. Bruce DL, Croley TF, Lee JS. Preoperative clonidine withdrawal syndrome. Anesthesiology 1979; 51:90.
  25. Metz S, Klein C, Morton N. Rebound hypertension after discontinuation of transdermal clonidine therapy. Am J Med 1987; 82:17.
  26. Houston MC. Abrupt cessation of treatment in hypertension: consideration of clinical features, mechanisms, prevention and management of the discontinuation syndrome. Am Heart J 1981; 102:415.
  27. Ram CV, Holland OB, Fairchild C, Gomez-Sanchez CE. Withdrawal syndrome following cessation of guanabenz therapy. J Clin Pharmacol 1979; 19:148.
  28. Colson P, Médioni P, Saussine M, et al. Hemodynamic effect of calcium channel blockade during anesthesia for coronary artery surgery. J Cardiothorac Vasc Anesth 1992; 6:424.
  29. Wijeysundera DN, Beattie WS, Rao V, et al. Calcium antagonists are associated with reduced mortality after cardiac surgery: a propensity analysis. J Thorac Cardiovasc Surg 2004; 127:755.
  30. Wijeysundera DN, Beattie WS. Calcium channel blockers for reducing cardiac morbidity after noncardiac surgery: a meta-analysis. Anesth Analg 2003; 97:634.
  31. Reves JG, Kissin I, Lell WA, Tosone S. Calcium entry blockers: uses and implications for anesthesiologists. Anesthesiology 1982; 57:504.
  32. Engelman RM, Hadji-Rousou I, Breyer RH, et al. Rebound vasospasm after coronary revascularization in association with calcium antagonist withdrawal. Ann Thorac Surg 1984; 37:469.
  33. Kizer JR, Kimmel SE. Epidemiologic review of the calcium channel blocker drugs. An up-to-date perspective on the proposed hazards. Arch Intern Med 2001; 161:1145.
  34. Legault C, Furberg CD, Wagenknecht LE, et al. Nimodipine neuroprotection in cardiac valve replacement: report of an early terminated trial. Stroke 1996; 27:593.
  35. Wagenknecht LE, Furberg CD, Hammon JW, et al. Surgical bleeding: unexpected effect of a calcium antagonist. BMJ 1995; 310:776.
  36. Zuccalá G, Pahor M, Landi F, et al. Use of calcium antagonists and need for perioperative transfusion in older patients with hip fracture: observational study. BMJ 1997; 314:643.
  37. Effects of calcium antagonists on the risks of coronary heart disease, cancer and bleeding. Ad Hoc Subcommittee of the Liaison Committee of the World Health Organisation and the International Society of Hypertension. J Hypertens 1997; 15:105.
  38. Grodecki-DeFranco P, Steinhubl S, Taylor P, et al. Calcium antagonist use and perioperative bleeding complications: an analysis of 5,157 patients. Circulation 1996; 94(suppl):I.
  39. Finegan BA, Hussain MD, Tam YK. Pharmacokinetics of diltiazem in patients undergoing coronary artery bypass grafting. Ther Drug Monit 1992; 14:485.
  40. Rosenman DJ, McDonald FS, Ebbert JO, et al. Clinical consequences of withholding versus administering renin-angiotensin-aldosterone system antagonists in the preoperative period. J Hosp Med 2008; 3:319.
  41. Coriat P, Richer C, Douraki T, et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 1994; 81:299.
  42. Bertrand M, Godet G, Meersschaert K, et al. Should the angiotensin II antagonists be discontinued before surgery? Anesth Analg 2001; 92:26.
  43. Kheterpal S, Khodaparast O, Shanks A, et al. Chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery. J Cardiothorac Vasc Anesth 2008; 22:180.
  44. Comfere T, Sprung J, Kumar MM, et al. Angiotensin system inhibitors in a general surgical population. Anesth Analg 2005; 100:636.
  45. Turan A, You J, Shiba A, et al. Angiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery. Anesth Analg 2012; 114:552.
  46. Pigott DW, Nagle C, Allman K, et al. Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive drug requirements. Br J Anaesth 1999; 83:715.
  47. Hasija S, Makhija N, Choudhury M, et al. Prophylactic vasopressin in patients receiving the angiotensin-converting enzyme inhibitor ramipril undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2010; 24:230.
  48. Drenger B, Fontes ML, Miao Y, et al. Patterns of use of perioperative angiotensin-converting enzyme inhibitors in coronary artery bypass graft surgery with cardiopulmonary bypass: effects on in-hospital morbidity and mortality. Circulation 2012; 126:261.
  49. Benedetto U, Melina G, Capuano F, et al. Preoperative angiotensin-converting enzyme inhibitors protect myocardium from ischemia during coronary artery bypass graft surgery. J Cardiovasc Med (Hagerstown) 2008; 9:1098.
  50. Benedetto U, Sciarretta S, Roscitano A, et al. Preoperative Angiotensin-converting enzyme inhibitors and acute kidney injury after coronary artery bypass grafting. Ann Thorac Surg 2008; 86:1160.
  51. Arora P, Rajagopalam S, Ranjan R, et al. Preoperative use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers is associated with increased risk for acute kidney injury after cardiovascular surgery. Clin J Am Soc Nephrol 2008; 3:1266.
  52. Hirsch IA, Tomlinson DL, Slogoff S, Keats AS. The overstated risk of preoperative hypokalemia. Anesth Analg 1988; 67:131.
  53. Nally BR, Dunbar SB, Zellinger M, Davis A. Supraventricular tachycardia after coronary artery bypass grafting surgery and fluid and electrolyte variables. Heart Lung 1996; 25:31.
  54. Khan NA, Campbell NR, Frost SD, et al. Risk of intraoperative hypotension with loop diuretics: a randomized controlled trial. Am J Med 2010; 123:1059.e1.
  55. Roizen MF. etic implications of concurrent diseases. In: Anesthesia, Miller RD (Ed), Churchill Livingstone, Philadelphia 2000. p.903.
  56. Farmer JA, Gotto AM. Dyslipidemia and other risk factors for coronary artery disease. In: A Textbook of Cardiovascular Medicine, Braunwald E (Ed), W.B. Saunders, Philadelphia 1997. p.1126.
  57. Physicians Desk Reference, Medical Economics Company, Montvale, NJ 2000.
  58. Hamilton-Craig I. Statin-associated myopathy. Med J Aust 2001; 175:486.
  59. Shek A, Ferrill MJ. Statin-fibrate combination therapy. Ann Pharmacother 2001; 35:908.
  60. Hollenberg M, Mangano DT, Browner WS, et al. Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. JAMA 1992; 268:205.
  61. Polanczyk CA, Goldman L, Marcantonio ER, et al. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med 1998; 129:279.
  62. Kapoor AS, Kanji H, Buckingham J, et al. Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies. BMJ 2006; 333:1149.
  63. Schouten O, Boersma E, Hoeks SE, et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 2009; 361:980.
  64. Dunkelgrun M, Boersma E, Schouten O, et al. Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg 2009; 249:921.
  65. Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 2004; 39:967.
  66. Blanco M, Nombela F, Castellanos M, et al. Statin treatment withdrawal in ischemic stroke: a controlled randomized study. Neurology 2007; 69:904.
  67. Nishina K, Mikawa K, Takao Y, et al. A comparison of rabeprazole, lansoprazole, and ranitidine for improving preoperative gastric fluid property in adults undergoing elective surgery. Anesth Analg 2000; 90:717.
  68. Cruickshank RH, Morrison DA, Bamber PA, Nimmo WS. Effect of i.v. omeprazole on the pH and volume of gastric contents before surgery. Br J Anaesth 1989; 63:536.
  69. Cantú TG, Korek JS. Central nervous system reactions to histamine-2 receptor blockers. Ann Intern Med 1991; 114:1027.
  70. Su FW, Beckman DB, Yarnold PA, Grammer LC. Low incidence of complications in asthmatic patients treated with preoperative corticosteroids. Allergy Asthma Proc 2004; 25:327.
  71. Reiss TF, Chervinsky P, Dockhorn RJ, et al. Montelukast, a once-daily leukotriene receptor antagonist, in the treatment of chronic asthma: a multicenter, randomized, double-blind trial. Montelukast Clinical Research Study Group. Arch Intern Med 1998; 158:1213.
  72. Williams RG, Yardley MP. Oral contraceptive therapy and the surgical management of ENT patients: a review of current clinical practice. Clin Otolaryngol Allied Sci 1990; 15:525.
  73. Vandenbroucke JP, Rosing J, Bloemenkamp KW, et al. Oral contraceptives and the risk of venous thrombosis. N Engl J Med 2001; 344:1527.
  74. Grady D, Wenger NK, Herrington D, et al. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study. Ann Intern Med 2000; 132:689.
  75. Miller J, Chan BK, Nelson HD. Postmenopausal estrogen replacement and risk for venous thromboembolism: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2002; 136:680.
  76. Hurbanek JG, Jaffer AK, Morra N, et al. Postmenopausal hormone replacement and venous thromboembolism following hip and knee arthroplasty. Thromb Haemost 2004; 92:337.
  77. Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA 1999; 281:2189.
  78. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998; 90:1371.
  79. Ruggiero SL, Dodson TB, Assael LA, et al. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg 2009; 67:2.
  80. Connelly CS, Panush RS. Should nonsteroidal anti-inflammatory drugs be stopped before elective surgery? Arch Intern Med 1991; 151:1963.
  81. Sethi GK, Copeland JG, Goldman S, et al. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. Department of Veterans Affairs Cooperative Study on Antiplatelet Therapy. J Am Coll Cardiol 1990; 15:15.
  82. Bashein G, Nessly ML, Rice AL, et al. Preoperative aspirin therapy and reoperation for bleeding after coronary artery bypass surgery. Arch Intern Med 1991; 151:89.
  83. Scher KS. Unplanned reoperation for bleeding. Am Surg 1996; 62:52.
  84. Watson CJ, Deane AM, Doyle PT, Bullock KN. Identifiable factors in post-prostatectomy haemorrhage: the role of aspirin. Br J Urol 1990; 66:85.
  85. Taggart DP, Siddiqui A, Wheatley DJ. Low-dose preoperative aspirin therapy, postoperative blood loss, and transfusion requirements. Ann Thorac Surg 1990; 50:424.
  86. Mangano DT, Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med 2002; 347:1309.
  87. Dacey LJ, Munoz JJ, Johnson ER, et al. Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients. Ann Thorac Surg 2000; 70:1986.
  88. Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med 2014; 370:1494.
  89. Katz J, Feldman MA, Bass EB, et al. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Ophthalmology 2003; 110:1784.
  90. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e326S.
  91. Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 35:64.
  92. Patrono C, Coller B, Dalen JE, et al. Platelet-active drugs : the relationships among dose, effectiveness, and side effects. Chest 2001; 119:39S.
  93. Stone DH, Goodney PP, Schanzer A, et al. Clopidogrel is not associated with major bleeding complications during peripheral arterial surgery. J Vasc Surg 2011; 54:779.
  94. Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996; 143:1.
  95. Dweck MR, Cruden NL. Noncardiac surgery in patients with coronary artery stents. Arch Intern Med 2012; 172:1054.
  96. Buur T, Larsson R, Berglund U, et al. Pharmacokinetics and effect of ticlopidine on platelet aggregation in subjects with normal and impaired renal function. J Clin Pharmacol 1997; 37:108.
  97. Beattie WS, Warriner CB, Etches R, et al. The addition of continuous intravenous infusion of ketorolac to a patient-controlled analgetic morphine regime reduced postoperative myocardial ischemia in patients undergoing elective total hip or knee arthroplasty. Anesth Analg 1997; 84:715.
  98. Douketis JD, Berger PB, Dunn AS, et al. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:299S.
  99. Van Hecken A, Schwartz JI, Depré M, et al. Comparative inhibitory activity of rofecoxib, meloxicam, diclofenac, ibuprofen, and naproxen on COX-2 versus COX-1 in healthy volunteers. J Clin Pharmacol 2000; 40:1109.
  100. Nunn B, Chamberlain PD. Effect of nabumetone (BRL 14777), a new anti-inflammatory drug, on human platelet reactivity ex vivo: comparison with naproxen. J Pharm Pharmacol 1982; 34:576.
  101. Goldenberg NA, Jacobson L, Manco-Johnson MJ. Brief communication: duration of platelet dysfunction after a 7-day course of Ibuprofen. Ann Intern Med 2005; 142:506.
  102. Cronberg S, Wallmark E, Söderberg I. Effect on platelet aggregation of oral administration of 10 non-steroidal analgesics to humans. Scand J Haematol 1984; 33:155.
  103. Borthwick E, Ferguson A. Perioperative acute kidney injury: risk factors, recognition, management, and outcomes. BMJ 2010; 341:c3365.
  104. Huyse FJ, Touw DJ, van Schijndel RS, et al. Psychotropic drugs and the perioperative period: a proposal for a guideline in elective surgery. Psychosomatics 2006; 47:8.
  105. Depaulo JR, Barker LR. Affective disorders. In: Principles of Ambulatory Medicine, Barker LR, Burton JR, Zieve PD (Eds), Williams and Wilkins, Baltimore 1995. p.166.
  106. Labos C, Dasgupta K, Nedjar H, et al. Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. CMAJ 2011; 183:1835.
  107. Ziegelstein RC, Meuchel J, Kim TJ, et al. Selective serotonin reuptake inhibitor use by patients with acute coronary syndromes. Am J Med 2007; 120:525.
  108. Yuan Y, Tsoi K, Hunt RH. Selective serotonin reuptake inhibitors and risk of upper GI bleeding: confusion or confounding? Am J Med 2006; 119:719.
  109. Auerbach AD, Vittinghoff E, Maselli J, et al. Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery. JAMA Intern Med 2013; 173:1075.
  110. Andreasen JJ, Riis A, Hjortdal VE, et al. Effect of selective serotonin reuptake inhibitors on requirement for allogeneic red blood cell transfusion following coronary artery bypass surgery. Am J Cardiovasc Drugs 2006; 6:243.
  111. Tully PJ, Cardinal T, Bennetts JS, Baker RA. Selective serotonin reuptake inhibitors, venlafaxine and duloxetine are associated with in hospital morbidity but not bleeding or late mortality after coronary artery bypass graft surgery. Heart Lung Circ 2012; 21:206.
  112. Xiong GL, Jiang W, Clare RM, et al. Safety of selective serotonin reuptake inhibitor use prior to coronary artery bypass grafting. Clin Cardiol 2010; 33:E94.
  113. Kim DH, Daskalakis C, Whellan DJ, et al. Safety of selective serotonin reuptake inhibitor in adults undergoing coronary artery bypass grafting. Am J Cardiol 2009; 103:1391.
  114. van Haelst IM, Egberts TC, Doodeman HJ, et al. Use of serotonergic antidepressants and bleeding risk in orthopedic patients. Anesthesiology 2010; 112:631.
  115. Tavakoli HR, DeMaio M, Wingert NC, et al. Serotonin reuptake inhibitors and bleeding risks in major orthopedic procedures. Psychosomatics 2012; 53:559.
  116. Mason PJ, Morris VA, Balcezak TJ. Serotonin syndrome. Presentation of 2 cases and review of the literature. Medicine (Baltimore) 2000; 79:201.
  117. Stack CG, Rogers P, Linter SP. Monoamine oxidase inhibitors and anaesthesia. A review. Br J Anaesth 1988; 60:222.
  118. Ray WA, Chung CP, Murray KT, et al. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009; 360:225.
  119. Larsen KA, Kelly SE, Stern TA, et al. Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 2010; 51:409.
  120. Wang W, Li HL, Wang DX, et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial*. Crit Care Med 2012; 40:731.
  121. Levenson JL. High-dose intravenous haloperidol for agitated delirium following lung transplantation. Psychosomatics 1995; 36:66.
  122. Tesar GE, Stern TA. Evaluation and treatment of agitation in the intensive care unit. Intensive Care Med 1986; 1:137.
  123. Wise MG, Terrell CD. Neuropsychiatric disorders; delirium, psychotic disorders, and anxiety. In: Principles of Critical Care, 2nd ed, Hall JB, Schmidt GA, Wood LD. (Eds), McGraw-Hill, New York 1998. p.965.
  124. Pozuelo L, et al. Preoperative Psychiatric Evaluation and Perioperative Management of Patients with Psychiatric Disorders. In: Comprehensive Hospital Medicine: An Evidence-Based Approach, Williams MV. (Ed), Saunders, Philadelphia 2007.
  125. Lenhardt R, Orhan-Sungur M, Komatsu R, et al. Suppression of shivering during hypothermia using a novel drug combination in healthy volunteers. Anesthesiology 2009; 111:110.
  126. Fischer SP, Schmiesing CA, Guta CG, Brock-Utne JG. General anesthesia and chronic amphetamine use: should the drug be stopped preoperatively? Anesth Analg 2006; 103:203.
  127. Stromer W, Michaeli K, Sandner-Kiesling A. Perioperative pain therapy in opioid abuse. Eur J Anaesthesiol 2013; 30:55.
  128. Gevirtz C, Frost EA, Bryson EO. Perioperative implications of buprenorphine maintenance treatment for opioid addiction. Int Anesthesiol Clin 2011; 49:147.
  129. Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med 2006; 144:127.
  130. Childers JW, Arnold RM. Treatment of pain in patients taking buprenorphine for opioid addiction #221. J Palliat Med 2012; 15:613.
  131. Wasson M, Beirne OR. Buprenorphine therapy: an increasing challenge in oral and maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:142.
  132. Center for Substance Abuse Treatment. Clinical Guiddelines for the Use of Buprenorphine in the Treatment of Opiod Addiction. Department of Health and Human Services, Rockville, MD 2004.
  133. Pharmacology of Opiod Analgesics. In: Anesthesiology, Longnecker DE. (Ed), McGraw-Hill, New York 2012.
  134. Huxtable CA, Roberts LJ, Somogyi AA, MacIntyre PE. Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care 2011; 39:804.
  135. Mushtaq S, Goodman SM, Scanzello CR. Perioperative management of biologic agents used in treatment of rheumatoid arthritis. Am J Ther 2011; 18:426.
  136. Grennan DM, Gray J, Loudon J, Fear S. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis 2001; 60:214.
  137. Rosandich PA, Kelley JT 3rd, Conn DL. Perioperative management of patients with rheumatoid arthritis in the era of biologic response modifiers. Curr Opin Rheumatol 2004; 16:192.
  138. Pieringer H, Stuby U, Biesenbach G. Patients with rheumatoid arthritis undergoing surgery: how should we deal with antirheumatic treatment? Semin Arthritis Rheum 2007; 36:278.
  139. Dixon WG, Watson K, Lunt M, et al. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 2006; 54:2368.
  140. Talwalkar SC, Grennan DM, Gray J, et al. Tumour necrosis factor alpha antagonists and early postoperative complications in patients with inflammatory joint disease undergoing elective orthopaedic surgery. Ann Rheum Dis 2005; 64:650.
  141. Bibbo C, Goldberg JW. Infectious and healing complications after elective orthopaedic foot and ankle surgery during tumor necrosis factor-alpha inhibition therapy. Foot Ankle Int 2004; 25:331.
  142. Wendling D, Balblanc JC, Brousse A, et al. Surgery in patients receiving anti-tumour necrosis factor alpha treatment in rheumatoid arthritis: an observational study on 50 surgical procedures. Ann Rheum Dis 2005; 64:1378.
  143. Bongartz T, Sutton AJ, Sweeting MJ, et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006; 295:2275.
  144. Curtis JR, Patkar N, Xie A, et al. Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor alpha antagonists. Arthritis Rheum 2007; 56:1125.
  145. Schneeweiss S, Setoguchi S, Weinblatt ME, et al. Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Arthritis Rheum 2007; 56:1754.
  146. den Broeder AA, Creemers MC, Fransen J, et al. Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study. J Rheumatol 2007; 34:689.
  147. Gardener GC. Management of Medications in Patients with Rheumatic Diseases during the Perioperative Period. In: Perioperative Management of Patients with Rheumatic Disease, Mandell BF. (Ed), Springer, 2012.
  148. Kelly WN, Fox IH, Palelleo TD. Gout and related disorders of purine metabolism. In: Textbook of Rheumatology, WB Saunders, Philadelphia 1989. p.1395.
  149. Wilbur K, Makowsky M. Colchicine myotoxicity: case reports and literature review. Pharmacotherapy 2004; 24:1784.
  150. Wallace SL, Singer JZ. Review: systemic toxicity associated with the intravenous administration of colchicine--guidelines for use. J Rheumatol 1988; 15:495.
  151. www.fda.gov/medwatch/safety/2005/safety05.htm#Flomax (Accessed on February 22, 2008).
  152. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 2005; 31:664.
  153. Schwinn DA, Afshari NA. Alpha1-adrenergic antagonists and floppy iris syndrome: tip of the iceberg? Ophthalmology 2005; 112:2059.
  154. Kaye AD, Clarke RC, Sabar R, et al. Herbal medicines: current trends in anesthesiology practice--a hospital survey. J Clin Anesth 2000; 12:468.
  155. Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA 2001; 286:208.