The Role of Selective Drug Therapy in Reducing Mortality in the High-risk Surgical Patients (Tranexamic Acid, Selective Bowel Tract Decontamination, Levosimendan, Beta-blockers, Insulin, Aprotinin, and Statins)

Among the numerous drugs which can be used perioperatively, there are few with a documented effect on survival according to randomized trials. Tranexamic acid, selective bowel tract decontamination, and levosimendan were found to increase survival. Beta-blockers, insulin, aprotinin, and statins increase mortality in the perioperative setting. We describe the evidence-based medicine supporting or discouraging the use of these drugs together with the physiopathology and the rationale supporting their use or their investigation. Furthermore, numerous other interventions which have at least one randomized trial to support their effect on perioperative mortality are summarized in a final table.