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 23 April 2018

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News

Abrupt withdrawal of drugs to prepare for surgery can be dangerous

Abruptly stopping drug treatment before surgery can be dangerous and increase the risk of postoperative complications, suggests an editorial in this week’s British Medical Journal.

News image

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Surgery, particularly major abdominal surgery, affects the rate at which stomach contents are emptied, so reducing the absorption of drugs. Patients may therefore have to wait several days before they can resume their normal medical routine.

David Noble and Henrik Kehlet, from Aberdeen, UK and Hvidovre, Denmark, cite research showing a significantly increased risk of adverse outcomes among patients whose drug regimens had been stopped before surgery.

"Complications are three times more likely in patients taking drugs unrelated to their surgery."

David Noble and Henrik Kehlet.

Patients taking therapeutic drugs that were unrelated to their surgery were three times as likely to have complications as those not taking medicines. And the longer the duration of abstinence, the higher was the complication rate.

Doctors need to ensure that drug treatments are resumed as soon as possible, write the authors, by providing alternative routes, medicines, and by reducing the need for opioid anesthesia.

But the pharmaceutical industry also needs to do more, they say. Guidance should be included in drug information leaftlets and in national drug formularies to help doctors provide alternative medicines and be aware of the symptoms associated with sudden withdrawal from treatment.

"Such is the scale of the problem that failing to prevent the consequences of drug withdrawal in the postoperative period should possibly be considered equivalent to those medication errors that have been called 'worse than a crime'", conclude the authors.

BMJ 2000; 321: 719-20
27 September 2000

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