Use Of Drugs While Undergoing Surgery

Patients with autoimmune inflammatory arthritis on immunosuppressant drugs need special consideration during an elective surgery. Every operation carries some risk of infection and non healing of wound even in healthy individuals. Rheumatoid arthritis, due to its vascular effects, is now being considered as an operative risk factor similar to diabetes, blood pressure and kidney failure. Assessment of cardiovascular risk and functional capacity should be carried out in all cases if it is likely to change the perioperative management. It is a common misconception among medical practitioners that these immunosuppressants complicate the post operative course. It must be realized that stopping of drug can lead to flare of arthritis which in turn can limit post operative rehabilitation and can necessitate addition of drug such as steroid.

Surgeries are of different types. Surgeries with major stress include those of heart, blood vessels, brain, abdomen, kidneys, spine and hip. Most of the other surgeries have mild to moderate perioperative risk (uterus, knee, eyes, teeth, breast, skin). Conventional antirheumatic drugs should be continued before and after the surgeries as they neither hamper wound healing nor increase the incidence of postoperative infection. Biologic drugs 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 prior to surgery due to possibility of excess intra operative bleeding.