THEMATIC REVIEW ON PERIOPERATIVE MEDICINEMAYOCheck for updatesPreoperative Management of CardiovascularMedications:A Society for PerioperativeAssessment and Quality Improvement(SPAQI)Consensus StatementSunil K.Sahai,MD;Konstantin Balonov,MD;Nathalie Bentov,MD,MA;Dennis M.(Mike)Bierle,MD;Lorinda M.Browning,MD;Kenneth C.Cummings lI,MD;Brian M.Dougan,MD;Megan Maxwell,MD:Geno J.Merli,MD;Adriana D.Oprea,MD;Bobbielean Sweitzer,MD;Karen F.Mauck,MD,MSc;and Richard D.Urman,MD,MBAAbstractCardiovascular conditions such as hypertension,arrhythmias,and heart failure are common in pa-tients undergoing anesthesia for surgical or other procedures.Numerous guidelines from variousspecialty societies offer variable recommendations for the perioperative management of these medi-cations.The Society for Perioperative Assessment and Quality Improvement identified a need toprovide multidisciplinary evidence-based recommendations for preoperative medication management.The society convened a group of 13 members with expertise in perioperative medicine and training inanesthesiology or internal medicine.The aim of this consensus effort is to provide perioperative cli-nicians with guidance on the management of cardiovascular medications commonly encounteredduring the preoperative evaluation.We used a modified Delphi process to establish consensus.Twenty-one classes of medications were identified:a-adrenergic receptor antagonists,angiotensin-converting enzyme inhibitors,angiotensin Il receptor blockers,angiotensin receptor-neprilysininhibitors,B-adrenoceptor blockers,calcium-channel blockers,centrally acting sympatholytic medi-cations,direct-acting vasodilators,loop diuretics,thiazide diuretics,potassium-sparing diuretics,endothelin receptor antagonists,cardiac glycosides,nitrodilators,phosphodiesterase-5 inhibitors,classIlI antiarrhythmic agents,potassium-channel openers,renin inhibitors,class I antiarrhythmic agents,sodium-channel blockers,and sodium glucose cotransportor-2 inhibitors.We provide recommenda-tions for the management of these medications preoperatively.2022 Mayo Foundation for Medical Education and Research Mayo Clin Proc.2022:97(9):1734-1751schemic heart disease and stroke havechronic comorbid conditions.Perioperativeremained the top 2 causes of mortalityclinicians must make informed recommen-From the Department of In-for over a decade,accounting for 27%dations for the preoperative management oftemal Medicne,The Univer-of deaths worldwide in 2019.Thus,medica-these medications.A blanket statement ofsity of Texas Medical Branchat Galveston.Galveston.TXtions prescribed for the management of car-holding all antihypertensive medications on(SK5.)Department of Anesdiovascular conditions,such as ischemicthe morning of surgery may result in the pa-thesiology and PerioperativeMedicine.Tufts Universityheart disease,arrhythmias,hypertension,tient presenting with elevated systemicSchool of Medicie.Boston.pulmonary hypertension,and heart failure,blood pressure levels on th
