Perioperative management considerations in patients taking prescribed psychoactive medications (including those for depression and Parkinson's disease)

Abstract

Purpose of reviewGiven the number of drugs available in the anaesthetist's armamentarium, drug interactions need to be managed. This is particularly true of psychoactive medications which primarily act on the central nervous system, targeting neurotransmitter pathways often affected by anaesthetic agents. This review gives an overview of the potential interactions of commonly used psychoactive medications with anaesthetic agents and hence their perioperative considerations. As anaesthetists will already be very familiar with the benzodiazepines, they will not be discussed here. Electroconvulsive therapy will also not be discussed. Recent findingsA wide range of psychoactive medications can interact with drugs commonly used in perioperative care including anaesthetic agents. There is limited clinical research into their effects and hence these interactions are based on known pharmacological actions. SummaryA cautious, pragmatic approach is recommended when managing patients on psychoactive medications requiring anaesthesia as part of their medical care.

Effectiveness of non-pharmacological interventions for treating post-stroke depression

“…[ 12 ] In addition, the treatment of antidepressants may be limited by the potential risk of drug interactions. [ 13 ] There are many non-pharmacological therapies for PSD that are safe, effective, and practical. [ 14 ] There have been some randomized controlled trials (RCTs) to study the effect of non-pharmacological intervention on PSD, and researchers have produced relevant reviews on this basis.…”

“…Pharmacological therapy can increase the risk of blurred vision, sexual dysfunction, urinary retention, tremors, severe insomnia, hypotension, and cerebral hemorrhage [12] . In addition, the treatment of antidepressants may be limited by the potential risk of drug interactions [13] . There are many non-pharmacological therapies for PSD that are safe, effective, and practical [14] .…”

Editorial: Neuroanaesthesiology editorial

“…Other members of this group include those with mood disorders, psychiatric disorders and patients with back pain taking benzodiazepines for ‘muscle relaxation’. Ho and Wong [6] provide a timely update on the interactions among the anaesthetic drugs and prescribed psychoactive medications. Of course, it is likely that even larger numbers of surgical patients use psychoactive substances without a prescription, but that is a topic that justifies a separate review.…”