O&G Cases · Perioperative care
Perioperative medication management — perioperative planning and rescue station
FRANZCOG-style management station covering PAUSE/BRIDGE/ACCP interruption, ENOXACAN-II four-week LMWH, Hollmann ACE-inhibitor morning withhold, AAGBI diabetes/VRIII, Woodcock/Marik steroids, and SGLT2 guideline hold.
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Candidate instruction. Mrs A is a 67-year-old listed for elective laparoscopic hysterectomy for early-stage endometrial cancer. Comorbidities: permanent atrial fibrillation (CHA2DS2-VASc 5), type 2 diabetes on metformin and empagliflozin, hypertension on enalapril, osteoarthritis on naproxen PRN, primary hypothyroidism on levothyroxine. Creatinine clearance 55 mL/min; HbA1c 7.8 percent. Lead the perioperative medication plan from pre-admission to discharge. Prefer sourced intervals (PAUSE, BRIDGE, ENOXACAN-II, Hollmann, AAGBI) over invented milligram ladders.[1]
References8ShowHide
- [1]Douketis JD, Spyropoulos AC, Murad MH, et al. Executive Summary: Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest, 2022.PMID 35964703
- [2]Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med, 2015.PMID 26095867
- [3]Douketis JD, Spyropoulos AC, Duncan J, Carrier M, et al. Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant. JAMA Intern Med, 2019.PMID 31380891
- [4]Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med, 2014.PMID 24679062
- [5]Hollmann C, Fernandes NL, Biccard BM A Systematic Review of Outcomes Associated With Withholding or Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Before Noncardiac Surgery. Anesth Analg, 2018.PMID 29381513
- [6]Marik PE, Varon J Requirement of perioperative stress doses of corticosteroids: a systematic review of the literature. Arch Surg, 2008.PMID 19075176
- [7]Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med, 2002.PMID 11919306
- [8]Barker P, Creasey PE, Dhatariya K, et al. Peri-operative management of the surgical patient with diabetes 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 2015.PMID 26417892