Endocrine medications

Oral anti hyperglycaemic medications

In general, these should be taken as normal on the day before the procedure, but not taken on the day of surgery. Local protocols often apply in a hospital. The Beacon Hospital uses a document no. PPS-ORG-68 on Qpulse, “Adult Patients with Diabetes Undergoing Surgery and Elective Procedures”.

Meglitinides

Take the day before the scheduled procedure, but do not take on the day of the procedure.

Examples: Nateglinide, Repaglinide

Metformin

Take the day before the scheduled procedure, but do not take on the day of the procedure.

Sulfonylureas

Take the day before the scheduled procedure, but do not take on the day of the procedure.

Examples: Glibenclamide, Gliclazide, Glimepiride, Glipizide, Tolbutamide

Thiazolidenones

Take the day before the scheduled procedure, but do not take on the day of the procedure.

Example: Pioglitazone

Dipeptidylpeptidase-4 (DPP-IV) Inhibitors (Gliptins)

Take the day before the scheduled procedure, but do not take on the day of the procedure.

Examples: Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Vildagliptin

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

Take the day before the scheduled procedure, but do not take on the day of the procedure.

Examples: Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide

Sodium-glucose co-transporter-2 (SGLT-2) InhibitorsGLT-2 inhibitors (gliflozins)

This medication should be held for 72 hours before surgery if the procedure is classified as major or major+/complex.

Examples: Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin

Acarbose

Take the day before the scheduled procedure, but do not take on the day of the procedure.

Insulins

Adjustments to a patient’s insulin regime is dependent of the nature of the regime itself. Locl protocols often apply. For example, in The Beacon Hospital, see doc no. PPS-ORG-68 on their Q-Pulse system, “Adult Patients with Diabetes Undergoing Surgery and Elective Procedures”.

Thyroid-related medications

Antithyroid medications

Continue this medication pre-operatively. If patient is taking propylthioiuracil, consider checking prothrombin time (PT) pre-operatively.

Examples: Carbimazole, Propylthiouracil

Thyroid hormones

Continue these medications pre-operatively.

Patients with known hypothyroidism or who are on treatment for hypothyroidism should have thyroid-stimulating hormone (TSH) checked pre-operatively to determine if treatment is adequate or if dose optimisation is needed.

Examples: Levothyroxine, Liothyronine

Corticoteroids (systemic)

Patients should receive their usual pre-operative dose of steroids on the day of surgery¹.

Abrupt withdrawal should be avoided in patients who have received systemic corticosteroids at the equivalent dose of prednisolone ≥ 10mg for longer than 3 weeks².

Inform the anaesthesiologist for the patient’s list that chronic high-dose steroid use has been identified, ‘stress-dose’ steroids are likely indicated intra-operatively.

Examples: Betamethasone, Budesonide, Deflazacort, Dexamethasone, Fludrocortisone, Hydrocortisone, Methylprednisolone, Prednisolone, Triamcinolone

References

1.

Liu MM, Reidy AB, Saatee S, Collard CD. Perioperative steroid management: Approaches based on current evidence. Anesthesiology. 2017;127(1):166-172.

2.

Freudzon L. Perioperative steroid therapy: Where’s the evidence? Current Opinion in Anesthesiology. 2018;31(1):39-42.