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Should I Take My Blood Pressure Medications the Day of Surgery?

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Updated September 04, 2008

Question: Should I Take My Blood Pressure Medications the Day of Surgery?
Answer:

Certain medications, including several high blood pressure drugs and some steroids, should be taken the day of surgery.

Generally, patients are advised not to eat or drink anything for several hours (8-12 is ideal) before surgery. This usually has little to do with the surgery itself. Rather, this guideline is in place because having solids or liquids in your stomach at the time of surgery greatly increases the risk of choking.

In other words, many surgeries done under general anesthesia (totally asleep) require a breathing tube and ventilator to carry out the process of breathing while the patient is asleep. Breathing tubes are inserted through the mouth, down the throat, and directly into the trachea. Medicines used to induce sleep before putting the breathing tube in place generally block the gag reflex, but this reflex can still be triggered by the passage of the tube through the back of the throat. If this happens, you will vomit, and the risk of the expelled material being inhaled is very high.

Keeping the stomach empty before surgery is exceptionally effective at minimizing this risk.

Despite this guideline, some medications should still be taken the morning of surgery. This is because it can be dangerous to suddenly stop taking them. Two blood pressure medications usually fall into this category – beta blockers and alpha blockers. Suddenly stopping either of these medications can cause rebound elevations in both blood pressure and heart rate. Other high blood pressure medications may fall into this category for different types of patients, so it’s important to ask your doctor about your specific medications.

If you’re told to take certain medications the day of surgery, don’t worry. Modern pills are designed to dissolve very quickly and will exit the stomach soon after being swallowed. Be sure to taken them with only small sips of water.

Though some sources say that any clear liquid is acceptable, many studies suggest that water is the safest choice. The lack of sugar, salt, or other complex carbohydrates minimizes the digestive stimulation that occurs after swallowing, ensuring that the stomach does not release digestive enzymes and liquids.

Sources:
1.Wouters KM, Byreddy R, Gleeson M, Morley AP.New approach to anaesthetizing a patient at risk of pulmonary aspiration with a Montgomery T-tube in situ.Br J Anaesth. 2008 Sep;101(3):354-7.

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