Preoperative medication management turnkey order set for nonemergent adult cardiac surgeryCentral MessagePerspective
Amanda Rea, DNP, CRNP,
Rawn Salenger, MD,
Michael C. Grant, MD, MSE,
Jennifer Yeh, PharmD,
Barbara Damas, PharmD,
Cheryl Crisalfi, MSN, RN,
Rakesh Arora, MD, PhD,
Alexander J. Gregory, MD,
Vicki Morton-Bailey, DNP, CRNP,
Daniel T. Engelman, MD,
Busra Cangut, MD,
Subhasis Chatterjee, MD,
Kevin W. Lobdell, MD,
Gina McConnell, BSN, RN,
Shannon Crotwell, BSN, RN,
Seenu Reddy, MD, MBA
Affiliations
Amanda Rea, DNP, CRNP
Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Towson, Md; Address for reprints: Amanda Rea, DNP, CRNP, Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Suite 302, 7601 Osler Dr, Towson, MD 21204.
Rawn Salenger, MD
Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Towson, Md; Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
Michael C. Grant, MD, MSE
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Md
Jennifer Yeh, PharmD
Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Towson, Md
Barbara Damas, PharmD
Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Mass
Cheryl Crisalfi, MSN, RN
Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Mass
Rakesh Arora, MD, PhD
Department of Surgery, Division of Cardiac Surgery, Harrington Heart and Vascular, Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
Alexander J. Gregory, MD
Department of Anesthesiology, Cumming School of Medicine & Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
Objective: The management of preoperative medications is an essential component of perioperative care for the cardiac surgical patient. This turnkey order set is part of a series created by the Enhanced Recovery After Surgery Cardiac Society, first presented at the Annual Meeting of The American Association for Thoracic Surgery in 2023. Numerous guidelines and expert consensus documents have been published to provide guidance in preoperative medication management. Our objective is to integrate these documents into an evidence-based order set that will facilitate standardized implementation of best practices for preoperative medication management for nonemergent adult cardiac surgery. Methods: Subject matter experts were consulted to translate existing guidelines and peer reviewed literature into a sample turnkey order set for the preoperative management of patients’ medications. Orders derived from consistent Class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the order set in bold type. Selected orders that were inconsistently Class I or IIA, Class IIB, or supported by published evidence, were also included in italicized type. Results: Holding antiplatelet and anticoagulant medications before nonemergent cardiac surgical procedures may reduce the risk of bleeding. Sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 agonists should also be discontinued to prevent acidosis and aspiration, respectively. Specific guidance for frequently used medications are complied within the manuscript, less frequently used medications are listed seperately. Conclusions: Despite strong recommendations from major guidelines and consensus manuscripts, variation exists in preoperative medication orders, with limited availability of succinct implementation tools. This turnkey order set may facilitate standardized comprehensive preoperative medication management before nonemergent cardiac surgery.
