Aclidinium (Eklira®), Glycopyrronium (Seebri®), Ipratropium (Atrovent®, Inhalvent®, Ipravent®), Tiotropium (Acopair®, Braltus®, Spiriva®, Tiogiva®), Umeclidinium (Incruse®) Combination products include Anoro®, Bevespi®, Combiprasal®, Combivent®, Duaklir®, Enerzair®, Ipramol®, Spiolto®, Trelegy®, Trimbow®, Ultibro®, Yanimo® but this list is not intended to be exhaustive |
Issues for Surgery |
For asthma and chronic obstructive pulmonary disease (COPD) – increased risk of exacerbation if omitted. |
Advice in the Perioperative period |
Elective and Emergency Surgery There are numerous inhaled preparations which contain antimuscarinics, either as single agents or in combination products with corticosteroids and / or beta agonists – all of these can be continued pre-operatively. Check active ingredients of currently available preparations in British National Formulary and see also Corticosteroids (Inhaled, Nebulised and Intranasal) monograph and Long-acting Beta2 Adrenoceptor Agonists monograph and Short-acting Beta2 Adrenoceptor Agonists monograph if applicable. Advise patients who are prescribed regular inhaled antimuscarinics but do not usually take them regularly to do so pre-operatively to optimise breathing prior to anaesthesia. Confirm the inhaler brand, device, and strength with the patient. Post-operative Advice If patients are unable to resume their usual inhaled medication post-operatively consider nebulised ipratropium if clinically appropriate. |
Interaction(s) with Common Anaesthetic Agents |
Antimuscarinic action |
Interaction(s) with other Common Medicines used in the Perioperative Period |
Antimuscarinic action Nefopam Concomitant administration of inhaled antimuscarinics with other medication known to have antimuscarinic effects has not been studied and is therefore not recommended by the manufacturers3, 4, 5, 6, 7; however, in practice monitor patient for adverse effects. |
Further Information |
None relevant.
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References |
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