Effective Perioperative Management Essay

Effective perioperative management of medications requires an understanding of the patient and his or her co morbidities so that the risk of perioperative decompensation can be gauged. This understanding stems from a thorough medical history that includes a comprehensive medication history to provide a complete inventory of the all prescription medications, all over-the-counter agents and all herbal medications. Out of 288 cases collected, 88% were in the age group of 41-80 years. Hypertension and diabetes combination was found to be the comorbities in majority of cases. In most of the cases medication use during perioperative settings was as per available literature indicating appropriate medication reconciliation in the hospital settings. The drug use pattern varied from the literature in some instances which included variations based on patient specific characteristics (like blood sugar levels, blood pressure levels and patient response after surgery),

Oral hypoglycemic agents were omitted on day of surgery and started after surgery day or at time of discharge or replaced by insulin. In few cases, oral hypoglycemic agents were continued on the day of surgery deviating from literature. In majority of cases insulin was given on the day of surgery (STAT dose was given based o the GRBS). Certain target blood glucose levels were set by the physician which was patient specific and insulin dose was adjusted based on those levels. If blood glucose levels were within the target range insulin was omitted and if not, STAT dose with short acting insulin was given based on GRBS values through intravenous route. Insulin to OHA and OHA to insulin conversion was seen in some cases which were based on physician judgment. Thyroid supplements were continued on the day of surgery in all cases. In very few cases, thyroid supplements were continued even when patient is nil by mouth which indicate variation from