In this episode of The Good GP, host Julia Rawlinson welcomes Dr Erin Horsley, an experienced GP anaesthetist, to provide practical guidance on pre-anaesthetic medication management for general practitioners. Focusing on how to prepare patients for elective surgery by knowing which medications to pause, continue, or adjust.

Highlights include:

• SGLT2 inhibitors: Advice on withholding these medications prior to surgery, especially for diabetic patients, due to risk of euglycaemic diabetic ketoacidosis.
• Diabetes medications and insulin: Specific instructions for perioperative management in procedures such as colonoscopy and gastroscopy.
• GLP-1 receptor agonists: Discussion on Ozempic, Wegovy, and Mounjaro. They emphasise that stopping them is not routinely required. Instead, they recommend clear fluid fasting protocols.
• Anticoagulants and antiplatelet agents: Practical approaches for managing DOACs, warfarin, and antiplatelet therapy based on procedure risk, including guidance on bridging and specialist consultation.
• Other medications: Tips on ACE inhibitors, opioids, and pain medications regarding continuation or withholding.
• Useful GP actions: An accurate medication list, allergy documentation, and direct communication with anaesthetic teams or pre-admission clinics.

Providing concise, evidence-based recommendations for medication management in the perioperative setting to assist GPs and ensure safer outcomes for their patients.

Links & Resources:

• NSW CEC Guidelines on Perioperative management of anticoagulant and antiplatelet agents
• WA Country Health Service Anaesthetic Services, Pre-operative Assessment and Investigations Guideline(good summary)
• Australian Diabetes Society Periprocedural DKA with SGLT-2 inhibitor
• Australian Diabetes Society Perioperative Diabetes and Hyperglycaemia Guidelines

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