Pharmacology of Acetaminophen, Nonsteroidal Antiinflammatory Drugs, and Steroid Medications: Implications for Anesthesia or Unique Associated Risks

• Published in: Anesthesiology clinics Vol. 35; no. 2; pp. e145 - e162
• Main Authors: Candido, Kenneth D., MD, Perozo, Oscar J., MD, Knezevic, Nebojsa Nick, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States 01-06-2017
• Subjects: Acetaminophen - pharmacology; Analgesics, Non-Narcotic - pharmacology; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia & Perioperative Care; Anti-Inflammatory Agents, Non-Steroidal - pharmacology; Humans; Pain, Postoperative - prevention & control; Postoperative Nausea and Vomiting - drug therapy; Steroids - pharmacology; Analgesia; Perioperative; Acetaminophen; NSAIDs; Intraoperative; Anesthesia; Steroids
• ISSN: 1932-2275
• DOI: 10.1016/j.anclin.2017.01.020

Acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids, historically used in perioperative management, are potent analgesic medications. They primarily inhibit the cyclooxygenase (COX) enzyme, decreasing the synthesis of prostaglandins, and modulating pain and temperature. Acetaminophen does not inhibit this synthesis at the inflammatory site. The primary mechanism of action of corticosteroids involves regulation of nuclear expression of genes involved in inflammatory pathways and other systemic effects. Metaanalyses have added purposeful perioperative indications, clarified misconceptions, and established protocols for administering these drugs. Some indications, doses, clinical considerations, and adverse effects need to be further studied.