surgery with sip of water medication can be taken Calcium channel blockers Usual dose Usual dose on morning of surgery with sip of water IV bolus or infusion Continue IV dose until medication can be taken ACE-inhibitors Usual dose Usual dose on morning of surgery with sip of water IV formulations Continue IV dose until medication can be taken Diuretics Stop day before IV Calcium channel blockers Restart when patient on oral liquids Potassium supplements Stop day before; consider checking potassium level Restart when patient on oral liquids Central-acting sympatholytics Usual dose Usual dose on morning of surgery with sip of water Transdermal clonidine/IV methyl dopa Restart when patient on oral liquids Peripheral sympatholytics Usual dose Usual dose on morning of surgery with sip of water Any IV formulation Restart when patient on oral liquids Α-blockers Usual dose Usual dose on morning of surgery with sip of water Any IV formulation Restart when patient on oral liquids vasodilators Usual dose Usual dose on morning of surgery with sip of water Any IV formulation Continue IV dose until medication can be taken Table II : Perioperative drug management for patients with CAD After procedure During surgery After procedure Day before surgery Drug
Continue IV dose if needed or until medication can be taken IV infusion if frank ischemia Usual dose Usual dose Nitroglycerin Usual dose + Usual dose + B-blockers Usual dose + B-blockers Usual dose Beta-blockers Continue IV dose if needed or until medication can be taken Usual dose morning of surgery Usual dose morning of surgery Usual dose Calcium channel blockers Restart postoperatively at discretion of surgeon Discontinue 1 week before surgery Aspirin Restart postoperatively at discretion of surgeon Discontinue 1 week before surgery Ticlopidine
Substitute drug if needed After surgery During surgery Day of surgery Day before surgery Drug Continue IV dose until medication can be taken PO IV phenytoin Usual dose on morning of surgery with sip of water Usual dose Phenytoin Continue IV dose until medication can be taken PO IV phenobarbital Usual dose on morning of surgery with sip of wate Usual dose Phenobarbital Continue IV dose until medication can be taken PO IV phenobarbital Usual dose on morning of surgery with sip of wate Usual dose Phenobarbital phenytoin or phenobarbital Continue IV dose until medication can be taken PO IV phenytoin or IV phenobarbital PO phenytoin or phenobarbital PO loading dose of phenytoin or phenobarbital Carbamazapine phenytoin or phenobarbital Continue IV dose until medication can be taken P PO phenytoin or phenobarbital PO phenytoin or phenobarbital PO loading dose of phenytoin or phenobarbital Valproic acid Table III : Perioperative drug management for patients with epilpsey.
Table IV : Perioperative drug management for patients on NSAIDs Substitute drug if needed After procedure During surgery Day of surgery Day before surgery Drug Low dose steroids IM prepration until patient is on oral liquids Discontinue 1 week before surgery NSAIDs with long half-life Low dose steroids IM prepration until patient is on oral liquids Discontinue 2-3 days before surgery NSAIDs with short half-life
Table V: Classification of surgical wounds Usual organism Wound infection rate(%) Example of typical procedures Definition Wound class S. aureus 2 Wide local excision of breast mass Nontraumatic, elective surgery; no entry of GI, biliary, tracheobronchial, respiratory, or GU tracts Clean Related to the viscus entered <10 Gastroctomy, hysterectomy Respiratory, genitourinary, GI tract entered but minimal contamination Depends on underlying disease 20 Ruptured appendix; resection of unprepared bowel Open, fresh, traumatic wounds; uncontrolled spillage from an unprepared hollow viscus; minor break in sterile technique Contaminated Depends on underlying disease 28-70 Intestinal fistula resection Open, traumatic, dirty wounds; traumatic perforated viscus; pus in the operative field Dirty
Table VI : Recommendations for antibiotic prophylaxis Adult dose before surgery Recommended antibiotics Likely pathogens Nature of operation 1- IV IV IV Cefazolin Vancomycin cefuroxime Staphylococci, conynbacteria, enteric Gram-ve bacilli Cardiac; prosthetic valve and other procedures 1- IV 1- IV 1- IV Cefazolin Vancomycin Cefoxitin Staphylococci, streptococci, enteric Gram-ve bacilli, clostridia Vascular: peripheral bypass or aortic surgery with prosthetic graft 1- IV 1- IV Cefazolin Vancomycin Staphylococci Orthopedic: total joint replacement or internal fixation of fractures 1- IV 1.5- IV 600-900 mg/ IV 1.5mg/kg IV Cefazolin Amipcillin-sulbactam Clindamycin Gentamycin Oral anaerobes, enteric Gram-ve bacilli, staphylococci Head and neck, entering oral cavity or pharynx 1- IV Cefazolin Enteric Gram-ve bacilli, Gram+ve cocci patient) 1- IV 1- IV 1- IV Cefazolin Cefoxitin Cefotatan Enteric Gram-ve bacilli, enterococci, clostridia Biliary of each at 1 PM, 2PM, AND 11 PM the day before an 8AM operation Oral: neomycin+erythromycin base Enteric Gram-ve bacilli,, anaerobes, enterococci Colorectal 1- IV 1- IV Cefoxitin Cefotatan Enteric Gram-ve bacilli,, anaerobes, enterococci Appendectomy (no perforation 1- IV Cefazolin Enteric Gram-ve Vaginal or abdominal