Patient Care,Safety,

Clinical Hub,References,PASS: Adult Preprocedure Assessment SAFE Service

Preoperative Medication Instructions

Preoperative Medication Instructions - Clinical Hub, References, PASS: Adult Preprocedure Assessment SAFE Service


1. Full Medication Recommendations – Delegation Protocol

2. Diabetes Management for Procedures on Patients coming from home - Adult & Pediatric: Go to section on “Preoperative Instructions for Ambulatory Procedures” in document.

3. Consult Preop PASS Service if any patient has a drug-eluting (DES) cardiac or carotid stent or is on Plavix or aspirin for other vascular stent.

COR-LOE Recommendations

4. Consult with Preop PASS Service if patient is taking Suboxone,  buprenorphine, pentazocine, or naltrexone due to potentially difficult period pain management issues.

5. Guidelines for anticoagulant “HOLD” when Regional/Neuraxial Anesthesia is planned:

Management of Antithrombotic Therapy in the Setting of Periprocedural, Regional Anesthesia and/or Pain
Procedures – Adult – Inpatient/Ambulatory - Clinical Practice Guideline

6. Condensed Summary of Preop Medication Instructions: It is impossible to list EVERY medication that patients might be taking. Below is a summary of the most important preoperative medication issues. Medications (unless noted below) may be taken at their usual schedule on the day of anesthesia/surgery. If there is a medication NOT mentioned here, and that medication has cardiovascular or pulmonary affects, please check with the anesthesiologist supervising the Preoperative PASS Clinic

Always Take…

Don’t Take...


7. Is propofol contraindicated for use in adults allergic to egg, soy or peanut?

8. Danger with Intraop Methylene Blue use and preop use of SSRIs

Methylene Blue Danger

Co-administration of selective serotonin reuptake inhibitors (SSRIs) with methylene blue during surgery may increase the risk of systemic toxicity, including serotonin syndrome (a potentially life-threatening condition). The coadministration of these agents is contraindicated according to prescribing information.

Mechanism: Administration of methylene blue (a potent monoamine oxidase inhibitor) with a serotonergic agent may result in excessive serotonin levels in the CNS and produce toxicity. Features of toxicity include confusion, disorientation, agitation, expressive aphasia, altered muscle tone in limbs, hypoxia, ocular symptoms, and depressed level of consciousness.