Preoperative Medication Management in Ambulatory Surgery: Best Practices and Challenges

Abstract

This review aims to summarize current evidence on the preoperative management of commonly used medications in patients undergoing ambulatory surgery. The preoperative assessment of patients undergoing ambulatory surgery must include careful medication review and individualized preoperative instructions, particularly in patients with multiple comorbidities and polypharmacy. Cardiovascular medications (i.e., beta-blockers and calcium channel blockers) should be continued perioperatively while renin-angiotensin-aldosterone system inhibitors and diuretics require individualized instructions due to hypotension risk. Hormone replacement therapies (i.e., levothyroxine, hydrocortisone, fludrocortisone) should be administered on the day of surgery. Neuropsychiatric medications including antipsychotics and antiparkinsonian drugs should be continued perioperatively to prevent serious adverse effects such as neuroleptic malignant syndrome. Herbal medicines and dietary supplements may have significant systemic effects (i.e., cardiovascular, neurological, anticoagulant); therefore, these agents should be discontinued two weeks before surgery. The increasing number of ambulatory surgical procedures, and patients with higher comorbidities are undergoing same-day surgery. This has made preoperative medication management an essential component of the preoperative assessment. Evidence-based recommendations addressing the perioperative management of commonly prescribed medications such as antihypertensives, antidiabetics, anticoagulants, and antiplatelet agents contribute to improving patient safety and surgical outcomes. However, as newer pharmacologic therapies continue to emerge further research is needed to guide their perioperative management.