Perioperative management of gastrointestinal and pulmonary agents

Name or class of drug	Clinical considerations	Recommended strategy for surgery with brief NPO state	Recommended strategy for surgery with prolonged NPO state
H2 blockers	No known adverse effects.	Continue therapy up to and including day of surgery.	Continue therapy up to and including day of surgery. Substitute IV forms available for prolonged postoperative NPO state.
Proton pump inhibitors (PPIs)	May increase risk for Clostridioides (difficile.	Continue therapy up to and including day of surgery.	Continue therapy up to and including day of surgery. Substitute IV H2 blockers or IV PPIs for prolonged postoperative NPO state.
Inhaled bronchodilators (beta agonists and anticholinergics)	No known adverse effects.	Continue therapy up to and including day of surgery.	Continue therapy up to and including day of surgery. Use nebulized forms if patient unable to comply with inhalation maneuver.
Theophylline	No known adverse effects but very narrow range between therapeutic and toxic level.	Discontinue the evening before surgery.	Discontinue the evening before surgery. Resume with PO intake. Use nebulized or inhaled beta agonist or anticholinergics.
Leukotriene inhibitors	No known adverse effects.	Continue therapy up to and including day of surgery.	Continue therapy up to and including day of surgery and resume when patient able to take oral medications.

NPO: nil per os (nothing by mouth); IV: intravenous; PO: per os (by mouth).

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