cardiovascular medication

Note: If the patients HR is less than 50bpm, withhold drugs that slow the heart on the day

(e.g. amioderone, beta-blockers, digoxin, verapimil).

ACEi & Angiotensin II inhibitors

Withhold one dose before surgery.

Decisions to continue (e.g. for heart failure or poorly controlled hypertension) should be made on a case by case basis by the anaesthetist.

If withheld prior to surgery, resume as soon as possible after (within 48 hours).

Alpha blockers, alpha-2 agonists (clonidine)

& centrally acting antihypertensives (methyldopa)

Continue; give before surgery.

Antiarrhythmics

Continue; give before surgery.

Beta-blockers

Continue; give on the morning of surgery.

Calcium channel blockers

Continue, give on the morning of surgery.

Exercise caution with left ventricular dysfunction (EF <40%).

Can be withheld if bradycardia or hypotension is present.

Diuretics

Continue; give before surgery.

May be witheld where hypotension or AKI is present. Decisions should be made on a case by case basis, balancing the risks of hypertension versus effects on renal function.

Nitrates

Continue, give before surgery.

If oral route unavailable, consider nitrate patches.

Statins

Continue; give before surgery.