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.
If patients are unable to resume their usual inhaled medication post-operatively consider nebulised ipratropium if clinically appropriate.
Interaction(s) with Common Anaesthetic Agents
Interaction(s) with other Common Medicines used in the Perioperative Period
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.