Non steroidal anti inflammatory drugs before surgery

We identified 28 947 persons with OHCA during 2001–10 and matched 115 788 controls with cases on age and sex. Within the 30-day case period, 3376 (%) persons were treated with an NSAID. Compared with non-users, NSAID users were more often women, had generally less cardiovascular diseases, such as ischaemic heart disease, myocardial infarction, and heart failure, but were more likely to have cancer and rheumatic diseases ( P for all <, Table 1 ). Moreover, NSAID users were more often treated with morphine, diuretics, and psychiatric medication ( P for all < ). Table 1 Baseline characteristics of subjects with out-of-hospital cardiac arrest divided into NSAID users and non-users

NSAIDs have anti-inflammatory (reduce inflammation), analgesic (relieve pain) and antipyretic (lower temperature) effects. Although different NSAIDs have different structures, they all work by blocking cyclooxygenase (COX) enzymes. There are two main types of COX enzymes: COX-1 and COX-2. Both types produce prostaglandins; however, the main function of COX-1 enzymes is to produce baseline levels of prostaglandins that activate platelets and protect the lining of the gastrointestinal tract, whereas COX-2 enzymes are responsible for releasing prostaglandins after infection or injury. Prostaglandins have a number of different effects, one of which is to regulate inflammation. Most NSAIDs inhibit both enzymes, although a few are available that mainly inhibit COX-2. The pain-relieving and anti-inflammatory effects of NSAIDs are mainly due to inhibition of COX-2, and their unwanted side effects are largely due to inhibition of COX-1.

Two studies compared different types of non-selective NSAIDs, namely ibuprofen versus diclofenac and piroxicam versus indomethacin. The trials did not find any differences between these NSAID types, but both trials had small sample sizes. One trial reported no differences in pain intensity between treatment groups that used selective or non-selective NSAIDs. One other trial compared diflunisal with paracetamol and showed no difference in improvement from baseline on pain intensity score. One trial showed a better global improvement in favour of celecoxib versus tramadol.

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

  • dose appropriately
  • pick the right drug and formulation?
    • Choose Cox-2 selective.
    • enteric coating (., aspirin) - a little protection, variable absorption
    • buffers (., aspirin) - a little protection, enhanced absorption
  • GI Protection?
    • PGE 2 analog - Misoprostol ® (Good evidence of efficacy)
    • Protectants (sucralfate) - no clear evidence
    • Omeprazole - no clear evidence
    • Cimetidine et al. - do not appear to be particularly effective for prevention.

Non steroidal anti inflammatory drugs before surgery

non steroidal anti inflammatory drugs before surgery

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

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