Concurrent drug therapy in patients undergoing surgery

Abstract

SummaryIn a retrosperiive study of 57 176 patients and a prospective study of 216 patients undergoing surgery, 24-32% of paiienis were receiving some concurrent medication. Between I0 and 16?h were taking drugs for cardiovascular disease. Of these, only 71% had iheir normal medication prescribed before surgery und only 41% received their drugs on the day of surgery. Key wordsDrugs; pre-operative treatment Concurrent drug therapy is important in patients undergoing surgery because of possible interactions with anacsthetic drugs and because of the difficulty in maintaining normal drug therapy in the peri-operative period when patients may fast for long periods of time. We report a survey of patient compliance at this time. Puiienrs and methodsThe anaesthetic records of 57 176 patients undergoing surgery in the Western Infirmary, Glasgow between April 1980 and November 1983 were reviewed previously.' On each form, the anaesthetist had recorded the presence and nature of any concurrent disease. In addition, coexistent drug therapy was notcd. These data were filed on computer and retrieved subsequently.In a prospective study of 216 consecutive patients undergoing general or orthopacdic surgery in two surgical units of the same hospital during April and May 1984, each patient was interviewed before and after surgery. Any concurrent disease and drug therapy were recorded. Regular medication was defined as more than 2 weeks' duration. Patient compliance with the regular medication on the day of surgery was determined from the nursing records. This was done without explaining the reasons to the nurses. in an attempt to avoid changing their normal practice. ResultsOf the 57 176 patients studied retrospectively, 13 703 (24%) were taking some medication regularly (Table I). Just under half of these latter patients (5 999; 10% of the total) were taking drugs for some disease of the cardiovascular system. This group represents some two-thirds of the 8 618 patients undergoing surgery who had cardiovascular disease. In the prospective study, 32% or the patients were taking regular medication and half of these (16%) were taking drugs for disease of the cardiovascular system ( DiscussionConcurrent drug therapy is common in patients undergoing surgery. Some one in four patients might be expected to be taking some medication at the time of their operation. It is likely that drugs prescribed for cardiovascular disease are most relevant with respect to drug interactions with anaesthetic agents and our data suggest that one in ten patients are taking these drugs. An unexpected but important result of our study is the frequency of acute withdrawal of concurrent medication before surgery. Both studies included patients undergoing elective and emergency surgery. The pattern of drug use was the same in both groups while the frequency of acute withdrawal of drugs was higher in the emergency patients (74 and 44% for emergency and elective patients, respectively). This may be hazardous for some drugsT2 in particular / J ' -adrenoreceptor a...

Do prescribed drugs always follow the patients to hospital?

“…Thus, we cannot exactly say what the likelihood is that a patient taking a 'category 3' drug as out-patient medication had that drug inadvertently omitted at hospitalization. It occurred in at least 6% of [12]. By limiting their focus to surgical patients, Duthie et al had a much higher proportion of admissions for emergency surgery.…”

“…Most of the errors in physician recall and medical records are errors of omission, in which the record fails to show a drug that has been prescribed in the past and is still being taken by the patient [2 3 5 7]. This being the case, it is not surprising that Duthie et al recently found that 29% the of patients taking major cardiovascular medications had these medications inadvertently stopped when they were admitted to hospital for surgery [12].…”

Pre-Anaesthetic Fitness for Surgery

“…iii) Drug history: Many patients requiring surgical procedure might suffer from unrelated disease and about 42% of them receive regular drug therapy 4,5 . These drugs may have interaction with anesthetic agents or may cause problems related to their sudden withdrawal during preoperative period.…”

Pre-Anaesthetic Assessment: It’s Role in Preventing Mortality

“…Drug history-Many patients requiring surgical procedure might suffer from unrelated disease and about 42% of them receive regular drug therapy 4,5 . These drugs may have interaction with anesthetic agents or may cause problems related to their sudden withdrawal during preoperative period.…”