Peri-operative Period Concept
Peri-operative period is time from the moment of making decision about operation to restore ability to work or its permanent loss. It includes the following periods:
- intraoperative (operation itself);
The main treatment method of patients with surgical profile is implementation of surgical intervention (operation).
Surgical operation is exercise carried out by means of mechanical action on patient’s tissues and organs with therapeutic and diagnostic purpose.
The operation involves at least two doctors (operator and assistant), operating nurse, anesthesiologist, and anesthetist. If operation is performed under local anesthesia, only surgeons and operating nurse are present.
UKCPA created handbook related to peri-operative medications.
Continue Drug Therapy or Stop it?
In connection with above-mentioned interactions between perioperative drug therapy, drugs for anesthesia and operation itself, it is necessary to decide – what medications can be taken during perioperative period, and which should be withdrawn. During preoperative examination, it may be necessary to change routine medication regimen long before surgery. The adoption of such decisions is especially difficult in the case of emergency operation, so it is important to foresee consequences, for example, of stopping intake of commonly taken medications.
Medications, which Are Recommended to Continue Taking
Some drugs should be continued to be taken before and after surgery to prevent aggravation of condition for which they were used or to avoid withdrawal syndrome development. Admission continuation may mean administering drug in variety of ways or switching to another drug with similar properties. The choice of alternative drugs should be made with caution, since even small changes can be accompanied by serious disruptions in drug bioavailability.
Table 1: Medications for Mandatory Application in Peri-operative Period
|Medications Group||Alternative Therapy||Notes|
|Antiepileptic drugs||Application of intravenous or
rectal medications. Liquid may be introduced through nasogastric tube
|Bioavailability of medications are diverse,
when changing other medications’ dosages.
stenocardia and arrythmia medications
|Apply intravenous injections in case of
oral application absence. There is possibility to change medication
|Arterial blood pressure monitoring|
|Medications for Parkinson’s disease treatment||Oral medications before surgery,
then chnage it to liquid or
dissolving medications, possible through nasogastric tube
|There is small risk of arrithmia and hypertension development in patients,
taking levodopa/dihydroxyphenylalanine. Некоторые
antiemetic drugs may increase могут levodopa level and worsen patient’s condition
|antipsychotic agents и antianxiety drugs||Some medications are available in form of injections,
sirup or suppositories
|There is no necessity in changing when using drug reservoirs.
Antianxiety drugs may decrease
demand in в anaesthetics and
|Medications for asthma treatment||Ordinary medications are given before surgery, then therapy is prolonged in form of inhalation||There is the greatest demand to achieve the best patients’ condition ever|
|Immunosuppressive agents||For patients with с transplanted organs
cyclosporine are released in form of injection.
|There is necessity of organs transplantation specialist|
|double-action antidepressants||Some medications are released in sirup form||Remember about serotonin syndrome and avoid
serotonergic medications –
pethidine and pentazocine