What are the options for treating patients with acute gouty arthritis postoperatively if they are unable to take oral agents? • Indomethacin or another NSAID per nasogastric tube or suppositories per rectum. These agents may be contraindicated if the patient is at risk for surgical bleeding or gastric ulcer disease, and in the setting of known …
Use of biologic DMARDs (bDMARDs) in the perioperative period for elective procedures It is generally recommended to plan for surgery at the end of the dosing cycle for each specific bDMARD. The bDMARD should be restarted once there are signs of good wound healing, no signs of infection, and sutures/staples have been removed; this is …
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Should the dosing of conventional synthetic DMARDs (csDMARDs) and targeted synthetic DMARDs (tsDMARDs) be altered prior to elective surgery? The choice to continue or stop DMARDs perioperatively depends on the underlying disease and disease activity, type of surgery, and type of DMARD. Minimizing the risk for infection and poor wound healing should be balanced against …
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How should agents used to treat or prevent osteoporosis be used around dental procedures? Osteonecrosis of the jaw (ONJ) has been associated with dental procedures in individuals who are being treated with medications to treat/prevent osteoporosis. Bone Strengthening Agents). Most cases are in individuals using bisphosphonates; however, a number of cases have been reported in …
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What is the standard antibiotic prophylaxis for prosthetic joint surgery? The goal of perioperative antibiotics is to reduce organism burden and prevent postoperative infection. For joint replacement surgery, cefazolin is typically used, dosed at 1 g IV within 60 minutes of incision, then every 8 hours for 1 day postoperatively. Vancomycin, 1 g IV every …
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How should steroids be dosed in the perioperative period and are stress dose steroids needed for all individuals who are taking or who have received recent steroids? Data suggests that many patients on corticosteroids may not require perioperative stress-dosing, especially if the patient is undergoing a minor procedure and is monitored closely in the perioperative …
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Should aspirin and NSAIDs be discontinued preoperatively in rheumatic disease? Patients treated with ASA and acetylsalicylate-containing medications may be at risk for increased surgical bleeding because these drugs impair platelet aggregation for the life of the platelet (7–10 days). ASA should be discontinued 7 to 10 days before planned surgery except in patients taking the …
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