Anesthetic Considerations for Patients on Psychotropic Drug Therapies

Abstract

Psychotropic drugs are used in the treatment of psychiatric and non-psychiatric conditions. Many patients who are on psychotropic medications may present for procedures requiring anesthesia. Psychotropic medications can have dangerous interactions with drugs commonly used in anesthesia, some of which can be life-threatening. In this review, we describe the current anesthetic considerations for patients on psychotropic drug therapies, including antidepressants, antipsychotics, mood stabilizers, anxiolytics, and stimulants. The pharmacology, side effects, and potential drug interactions of the commonly prescribed psychotropic drug therapies with anesthetic agents are described. Further, we highlight the current recommendations regarding the cessation and continuation of these medications during the perioperative period.

Anesthetic management of a patient with methamphetamine-associated pulmonary arterial hypertension undergoing laparoscopic cholecystectomy

“…In the present case, we did not use nitric oxide because its usage in patients undergoing non-cardiac surgery is not accepted under the Japanese health insurance system. In addition, patients that abuse methamphetamine have altered anesthetic requirements [ 12 ]; thus, it is necessary to use a BIS monitor to monitor the depth of anesthesia.…”

Robotic Anesthesia: A Vision for 2050

“…50 There is, however, a significant pharmacological range of dose to achieve a given sedation target. [51][52][53][54] Another limitation was that Sedasys was only able to decrease the propofol dose and not to increase it automatically; any increase needed to be effectuated by the physician, rather defeating the object of a closed loop and increasing reliance on human experience or error and introducing a long delay before reaching a sufficiently deep sedation level. Many gastrointestinal specialists working with a dedicated anesthesiologist service were used to Example for a closed-loop system interface: note the various components of anesthesia represented as bispectral index ("hypnosis"), Analgoscore for pain assessment during general anesthesia and neuromuscular blockade both in core (representing larynx or diaphragm) and peripheral muscles (adductor pollicis muscle).…”

“…There is, however, a significant pharmacological range of dose to achieve a given sedation target. 51–54 Another limitation was that Sedasys was only able to decrease the propofol dose and not to increase it automatically; any increase needed to be effectuated by the physician, rather defeating the object of a closed loop and increasing reliance on human experience or error and introducing a long delay before reaching a sufficiently deep sedation level. Many gastrointestinal specialists working with a dedicated anesthesiologist service were used to deeper sedation levels than Sedasys was designed to provide.…”

Anesthetic Concerns in Psychiatric Disease

“…The mechanism of action of lamotrigine is believed to be inhibition of sodium and calcium channels in presynaptic neurons and decreased glutamine, and increased GABA release. The decreased glutamate release can reduce ketamine anesthetic response in patients [31].…”

“…Due to possible unopposed alpha-adrenergic receptor activation in combination with effects of cocaine, beta-blocker use is contraindicated in patients with acute cocaine toxicity due to unopposed alpha-adrenergic stimulation, coronary vasoconstriction, reduced nitric oxide production, and increased endothelin-1 levels [31,123]. It is recommended to utilize nitric oxide mediated vasodilators, calcium channel blockers, and non-selective beta-blockers to manage hemodynamic instability in acute cocaine intoxication [31]. Acute intoxication causes sympathetic stimulation and may result in increased anesthetic requirements.…”