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Bernhard Riedel - One of the best experts on this subject based on the ideXlab platform.
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statin therapy within the Perioperative Period
Anesthesiology, 2008Co-Authors: Yannick Le Manach, P Coriat, Charles D Collard, Bernhard RiedelAbstract:STATINS are highly effective in lowering serum cholesterol concentrations through 3-hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase inhibition and thus are central to the primary and secondary prevention of cardiovascular disease. More than 50% of patients undergoing major vascular surgery and 80% undergoing cardiac surgery are on chronic statin therapy. 1,2 Statins also exert numerous lipid-independent or “pleiotropic” effects (effects that were not expected during drug development) as a result of their ability to inhibit the inflammatory response, reduce thrombosis, enhance fibrinolysis, decrease platelet reactivity, inhibit cell growth, reduce ischemia–reperfusion injury, and restore endothelial function. These beneficial effects result predominantly from the modulation of the complex interplay between the pathologic triad of inflammation, dynamic obstruction, and thrombosis. 3 This triad is integral to the surgical stress response and central to postoperative outcomes. However, recent reports noted that patients who undergo postoperative statin withdrawal experience increased cardiac morbidity when compared with patients who undergo early postoperative readministration of statins or with patients not treated with statins. 1,4 These facts raise several important questions for the anesthesiologist regarding statin therapy during the Perioperative Period: (1) Do statins modify Perioperative risk? (2) Is continuation or discontinuation of statin therapy during the Perioperative Period associated with additional risk? (3) Do the potential benefits of statin therapy outweigh the potential risks? This review of the literature explores the risks and benefits associated with Perioperative statin therapy.
Yannick Le Manach - One of the best experts on this subject based on the ideXlab platform.
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statin therapy within the Perioperative Period
Anesthesiology, 2008Co-Authors: Yannick Le Manach, P Coriat, Charles D Collard, Bernhard RiedelAbstract:STATINS are highly effective in lowering serum cholesterol concentrations through 3-hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase inhibition and thus are central to the primary and secondary prevention of cardiovascular disease. More than 50% of patients undergoing major vascular surgery and 80% undergoing cardiac surgery are on chronic statin therapy. 1,2 Statins also exert numerous lipid-independent or “pleiotropic” effects (effects that were not expected during drug development) as a result of their ability to inhibit the inflammatory response, reduce thrombosis, enhance fibrinolysis, decrease platelet reactivity, inhibit cell growth, reduce ischemia–reperfusion injury, and restore endothelial function. These beneficial effects result predominantly from the modulation of the complex interplay between the pathologic triad of inflammation, dynamic obstruction, and thrombosis. 3 This triad is integral to the surgical stress response and central to postoperative outcomes. However, recent reports noted that patients who undergo postoperative statin withdrawal experience increased cardiac morbidity when compared with patients who undergo early postoperative readministration of statins or with patients not treated with statins. 1,4 These facts raise several important questions for the anesthesiologist regarding statin therapy during the Perioperative Period: (1) Do statins modify Perioperative risk? (2) Is continuation or discontinuation of statin therapy during the Perioperative Period associated with additional risk? (3) Do the potential benefits of statin therapy outweigh the potential risks? This review of the literature explores the risks and benefits associated with Perioperative statin therapy.
Rani Chovatiya - One of the best experts on this subject based on the ideXlab platform.
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risk of opioid use disorder from exposure to opioids in the Perioperative Period a systematic review
Anesthesiology and Pain Medicine, 2020Co-Authors: Khalid M Malik, Farnad Imani, Rena Beckerly, Rani ChovatiyaAbstract:: Opioid use disorder, a major source of morbidity and mortality globally, is regularly linked to opioids given around the time of surgery. Perioperative Period, however, is markedly heterogeneous, with the diverse providers using opioids distinctively, and the various drivers of opioid misuse at-play dissimilarly, throughout the Perioperative Period. The risk of opioid use disorder may, therefore, be different from opioids given at the various phases of Perioperative care, and the ensuing recommendations for their use may also be dissimilar. Systematic search and analysis of the pertinent literature, following the accepted standards, showed an overall increased risk of misuse from the Perioperative opioids. However, the analyzed studies had significant methodological limitations, and were constrained mainly to the out-patient phase of the Perioperative Period. Lacking any data, this risk, therefore, is unknown for intraoperative and postoperative recovery Periods. Consequently, no firm recommendations can be extended to anesthesia providers generally managing these Perioperative stages. Furthermore, with significant methodological limitations, the current recommendations for opioid use after surgery are also arbitrary. Thus, though proposals for Perioperative opioid use are formulated in this article, substantive recommendations would require clear delineation of these risks, while avoiding the limitations noted in this review.
Nathan Spell - One of the best experts on this subject based on the ideXlab platform.
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Stopping and restarting medications in the Perioperative Period.
Medical Clinics of North America, 2001Co-Authors: Nathan SpellAbstract:A frequent task of the consulting physician regarding the patient approaching surgery is to advise on the safe use of long-term medications in the Perioperative Period. The physician needs to understand the patient and his or her diseases, the anticipated surgery and anesthesia, and the expected postoperative course and its potential complications. Because few long-term medications have been subjected to controlled trials in the Perioperative Period, recommendations must be drawn from opinions of experts, from case reports and other experiential data, and from theoretic considerations. Several reviews of preoperative medication use have been published, 6,16,24 but less has been written about restarting medications after surgery. Although a general consensus exists for many medications, consensus is lacking for others. 16 An additional challenge is the rapid pace at which new medications come to market, forcing physicians to extrapolate from experiences with similar drugs or to rely on the manufacturers' recommendations for Perioperative use. To explore the complexity of this topic, a hypothetical case is used to illustrate general principles and to initiate a discussion on specific medications.
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stopping and restarting medications in the Perioperative Period
Medical Clinics of North America, 2001Co-Authors: Nathan SpellAbstract:Medical consultants in the care of patients undergoing surgery have many tasks. One of these is to recommend the safest and most effective use of medication in the Perioperative Period. The physician must balance the urge to simplify with the need to maintain stability in the patient and his or her chronic diseases. The physician must consider the patient, the particulars of the patient's life, the patient's illnesses, and the patient's desires. At times, the physician can rely on well-supported data for guidance. Much of the time, however, the physician must operate on limited information and hunches about the best advice. Above all, the physician must communicate clearly with the patient, the surgeon, the anesthesiologist, and other members of the medical team to ensure a safe transition through surgery and return to good health.
Ronan P Oconnell - One of the best experts on this subject based on the ideXlab platform.
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antiplatelet agents in the Perioperative Period
Archives of Surgery, 2009Co-Authors: James M Oriordan, Ronan Margey, Gavin Blake, Ronan P OconnellAbstract:Objective To determine the use of the 3 major classes of antiplatelet drugs (aspirin, thienopyridines, and glycoprotein IIb/IIIa inhibitors), their management in the Perioperative Period, and the risks associated with premature withdrawal. Data Sources We reviewed the PubMed, EMBASE, and Cochrane databases using the terms antiplatelet agents in the Perioperative Period , antiplatelet agents and management of bleeding , drug-eluting stents and stent thrombosis , substitutes for antiplatelet agents , and premature withdrawal of antiplatelet agents . Study Selection Randomized, double-blind, placebo-controlled trials; prospective observational studies; review articles; clinical registry data; and guidelines of professional bodies pertaining to antiplatelet agents were included. Data Extraction and Synthesis Two researchers independently read the selected abstracts and selected the studies that matched the inclusion criteria. Any discordance between the 2 researchers was resolved by discussion so that 99 articles were finally included. Conclusions Aspirin use should not be stopped in the Perioperative Period unless the risk of bleeding exceeds the thrombotic risk from withholding the drug. With the exception of recent drug-eluting stent implantation, clopidogrel bisulfate use should be stopped at least 5 days prior to most elective surgery. Use of glycoprotein IIb/IIIa inhibitors must be discontinued preoperatively for more than 12 hours to allow normal hemostasis. Premature withdrawal of antiplatelet agents is associated with a 10% risk of all vascular events. Following drug-eluting stent implantation, withdrawal is associated with stent thrombosis and potentially fatal consequences. No definitive guidelines exist to manage patients who are actively bleeding while taking these drugs.