Perioperative medication reconciliation: what is the recommended approach to essential medications?

• A. Discontinue all routine medications
• B. Hold antihypertensives only
• C. Continue essential meds with timing adjustments
• D. Stop all antidiabetics

Answer: (C)

Continuing essential medications with timing adjustments keeps the patient’s physiology stable through the surgical period. Abruptly stopping drugs that maintain blood pressure, glucose control, seizure threshold, thyroid function, and other critical systems can lead to dangerous swings—hypertensive crises, hyper- or hypoglycemia, seizures, or thyroid instability—that complicate anesthesia and recovery. By keeping these meds on board and adjusting when they’re taken around the procedure (for example, scheduling doses to align with NPO status, switching to IV or short-acting forms if needed, or withholding certain agents only when specifically indicated), you maintain a safer balance. That’s why the best approach is to continue essential meds with appropriate timing adjustments rather than stopping them all or restricting only one class.