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Khambaty M, Silbert RE, Devalapalli AP, Kashiwagi DT, Regan DW, Sundsted KK, Mauck KF. Practice-Changing Updates in Perioperative Medicine Literature 2020-2021: A Systematic Review. Am J Med 2022; 135:1306-1314.e1. [PMID: 35820457 DOI: 10.1016/j.amjmed.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022]
Abstract
Recent literature published in a variety of multidisciplinary journals has significantly influenced perioperative patient care. Distilling and synthesizing the clinically important literature can be challenging. This review summarizes practice-changing articles in perioperative medicine from the years 2020 and 2021. Embase, Ovid, and EBM reviews databases were queried from January 2020 to December 2021. Inclusion criteria were original research, systematic review, meta-analysis, and important guidelines. Exclusion criteria were conference abstracts, case reports, letters, protocols, pediatric and obstetric articles, and cardiac surgery literature. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ont., Canada). A modified Delphi technique was used to identify 9 practice-changing articles. We identified another 13 articles for tabular summaries, as they were relevant to an internist's perioperative evaluation of a patient. Articles were selected to highlight the clinical implications of new evidence in each field. We have also pointed out limitations of each study and clinical populations where they are not applicable.
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Affiliation(s)
- Maleka Khambaty
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN.
| | - Richard E Silbert
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
| | - Aditya P Devalapalli
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
| | - Deanne T Kashiwagi
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN; Division of Internal Medicine, Sheikh Shakhbout Medical City in partnership with Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Dennis W Regan
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
| | - Karna K Sundsted
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
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Sahai SK, Balonov K, Bentov N, Bierle DMM, Browning LM, Cummings KC, Dougan BM, Maxwell M, Merli GJ, Oprea AD, Sweitzer B, Mauck KF, Urman RD. Preoperative Management of Cardiovascular Medications: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clin Proc 2022; 97:1734-1751. [PMID: 36058586 DOI: 10.1016/j.mayocp.2022.03.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 01/19/2022] [Accepted: 03/21/2022] [Indexed: 10/14/2022]
Abstract
Cardiovascular conditions such as hypertension, arrhythmias, and heart failure are common in patients undergoing anesthesia for surgical or other procedures. Numerous guidelines from various specialty societies offer variable recommendations for the perioperative management of these medications. The Society for Perioperative Assessment and Quality Improvement identified a need to provide multidisciplinary evidence-based recommendations for preoperative medication management. The society convened a group of 13 members with expertise in perioperative medicine and training in anesthesiology or internal medicine. The aim of this consensus effort is to provide perioperative clinicians with guidance on the management of cardiovascular medications commonly encountered during the preoperative evaluation. We used a modified Delphi process to establish consensus. Twenty-one classes of medications were identified: α-adrenergic receptor antagonists, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, angiotensin receptor-neprilysin inhibitors, β-adrenoceptor blockers, calcium-channel blockers, centrally acting sympatholytic medications, direct-acting vasodilators, loop diuretics, thiazide diuretics, potassium-sparing diuretics, endothelin receptor antagonists, cardiac glycosides, nitrodilators, phosphodiesterase-5 inhibitors, class III antiarrhythmic agents, potassium-channel openers, renin inhibitors, class I antiarrhythmic agents, sodium-channel blockers, and sodium glucose cotransportor-2 inhibitors. We provide recommendations for the management of these medications preoperatively.
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Affiliation(s)
- Sunil K Sahai
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX.
| | - Konstantin Balonov
- Department of Anesthesiology and Perioperative Medicine, Tufts University School of Medicine, Boston, MA
| | - Nathalie Bentov
- Department of Family Medicine, University of Washington, Seattle, WA
| | | | | | | | - Brian M Dougan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Megan Maxwell
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Geno J Merli
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Adriana D Oprea
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - BobbieJean Sweitzer
- University of Virginia School of Medicine, Charlottesville, VAkInova Health Systems, Falls Church, VA; Inova Health Systems, Falls Church, VA
| | - Karen F Mauck
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Bierle DM, Wight EC, Ganesh R, Himes CP, Sundsted KK, Jacob AK, Mohabbat AB. Preoperative Evaluation and Management of Patients With Select Chronic Gastrointestinal, Liver, and Renal Diseases. Mayo Clin Proc 2022; 97:1380-1395. [PMID: 35787866 DOI: 10.1016/j.mayocp.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/22/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
Patients with chronic gastrointestinal, hepatic, and renal disease are frequently encountered in clinical practice. This is due in part to the rising prevalence of risk factors associated with these conditions. These patients are increasingly being considered for surgical intervention and are at higher risk for multiple perioperative complications. Many are able to safely undergo surgery but require unique considerations to ensure optimal perioperative care. In this review, we highlight relevant perioperative physiology and outline our approach to the evaluation and management of patients with select chronic gastrointestinal, hepatic, and renal diseases. A comprehensive preoperative evaluation with a multidisciplinary approach is often beneficial, and specialist involvement should be considered. Intraoperative and postoperative plans should be individualized based on the unique medical and surgical characteristics of each patient.
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Affiliation(s)
- Dennis M Bierle
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Elizabeth C Wight
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Carina P Himes
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karna K Sundsted
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam K Jacob
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arya B Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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