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Perioperative medication management

Visala Muluk, MD
Steven L Cohn, MD, FACP, SFHM
Christopher Whinney, MD
Section Editors
Andrew D Auerbach, MD, MPH
Natalie F Holt, MD, MPH
Deputy Editor
Daniel J Sullivan, MD, MPH


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 [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 management of the surgical patient taking glucocorticoids".)


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.

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Literature review current through: Nov 2017. | This topic last updated: Feb 09, 2017.
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