Sept. 22, 2000 -- Patients getting ready for surgery need to pack more than their toothbrush and favorite reading materials. Too many may be forgetting to bring along any medications they regularly take, thinking they don't need them. But that may prove to be a dangerous mistake.
One study found that patients who stopped taking medications for chronic conditions, especially those affecting the heart, were more than threetimes more likely to have complications after their surgery than did people who were not on medications before surgery. The study indicates doctors need to do a better job reviewing what medications patients are on prior to surgery and whether they need to be withdrawn. And patients must do their part, says an anesthesiologist, in making sure that gets done.
"Perhaps they should simply ask what their doctors intend to do about their drug therapy leading up to and after their operation. Then their doctors will have to think about the problem and explain what they intend to do," David Nobel, a consultant in anesthesia and intensive care medicine at Grampian University Hospital in Aberdeen, Scotland, tells WebMD. Nobel and a colleague wrote an editorial about the problem of inappropriate drug discontinuation prior to surgery that was published in the British Journal of Medicine.
Some medications, such as aspirin, are usually stopped before surgery, experts say, but other drugs, such beta-blockers for heart conditions, may be needed during the time of surgery.
Michael F. Roizen, MD, professor and chair of the department of anesthesia and critical care at the University of Chicago's Pritzker School of Medicine, tells WebMD he is not sure to what extent the U.S. shares the problem outlined in the editorial.
He says much of the blame may lie with patients who misinterpret instructions to not eat or drink before surgery and fail to take their medications, or do not keep visits scheduled with an anesthesiologist or surgeon before the surgery so they can be prepared. In the past, such preparation may not have been as crucial because people were often admitted to the hospital the night before their procedure. This is rarely done today, says Roizen.
"Over 70% [of patients] come in the morning of surgery -- not the night before -- and we have them bring their medicines to the hospital. It is important for the patient to make sure that they do take their medications. So often they may be told 'No food or drink after midnight' and they may interpret that to mean no pills. The story for patients is to take all your medications [as instructed]," says Roizen.
Roizen adds that the use of specific herbs, including comfrey, ephedra, St. John's wort, ginger, garlic and valerian, feverfew, chamomile, echinacea, and ginkgo biloba, should be halted as early as three weeks prior to surgery. Some can increase bleeding during surgery, reduce the effectiveness of pain medication, increase blood pressure, and prolong the effects of anesthesia. Afterward, they may be taken again in consultation with a physician, as some may prove helpful in speeding the healing process.