Use Of Drugs While Undergoing Surgery
Patients with inflammatory arthritis on immunosuppressant drugs need special considerations during elective surgery. Every operation carries some risk of infection and nonhealing of wounds, even in healthy individuals. Due to its vascular effects, Rheumatoid arthritis is considered an operative risk factor similar to diabetes, blood pressure, and kidney failure. Assessment of the patient's cardiovascular risk and functional capacity should be carried out if it is likely to change the perioperative management. It is a common misconception among medical practitioners that these immunosuppressants complicate the postoperative course. It must be realized that stopping the drug can lead to a flare of arthritis, limiting postoperative rehabilitation and necessitating the addition of medications such as a steroid.
Surgeries are of different types. Surgeries with major stress include those related to the heart, blood vessels, brain, abdomen, kidneys, spine, and hip. Most of the other surgeries (uterus, knee, eyes, teeth, breast, skin) have mild to moderate perioperative risk. Conventional antirheumatic drugs should be continued before and after the surgeries. They neither hamper wound healing nor increase the incidence of postoperative infection. However, the biological agents should be stopped before surgery as per recommendations. A small additional dose of steroid is required during moderate to major surgical stress.
Anti-inflammatory painkillers should be stopped 2-4 days before surgery due to a possibility of excess intraoperative bleeding.