Perioperative Outcome of Dyssomnia Patients on Chronic Methylphenidate Use

Abstract

Methylphenidate is frequently prescribed for attention deficit hyperactivity disorder, narcolepsy, and other sleep disorders requiring psychostimulants. Our report is based on 2 different clinical experiences of patients with chronic methylphenidate use, undergoing general anesthesia. These cases contrast different strategies of taking versus withholding the drug treatment on the day of surgery. From the standpoint of anesthetic management and patient safety, the concerns for perioperative methylphenidate use are mainly related to cardiovascular stability and possible counteraction of sedatives and anesthetics.

Perioperative risks of narcolepsy in patients undergoing general anesthesia: A case-control study

“…Moreover, treatment interruption could result in withdrawal syndrome, which includes hypersomnia [41], or a delay in emergence from anesthesia [12]. Nonetheless, in several reported cases of acute preoperative interruption of treatment with CNS stimulants, patients had uneventful courses during anesthesia and recovery [8,14,20]. Our institution's EHRs do not track medications taken from a patient's outpatient supply in the morning before surgery; however, patients are commonly instructed to take most of their home medications as usual with the exception of select antihypertensives (e.g., angiotensin receptor blockers), dietary and herbal supplements, hypoglycemics, and anticoagulants.…”

“…Few articles have presented case reports [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and case series [22,23] related to the anesthetic management of narcoleptic patients. Shortterm or long-term amphetamine use may interfere with anesthesia management.…”

Central Disorders of Hypersomnolence, Restless Legs Syndrome, and Surgery With General Anesthesia: Patient Perceptions

“…Kleine-Levin syndrome, also a central disorder of hypersomnolence, refers to a syndrome consisting of bouts of recurrent hypersomnia separated by periods of relative normalcy. Potential concerns for the perioperative management of patients with central disorders of hypersomnolence raised by case reports and small case series include: (1) the appearance of peri-operative cataplexy, sleepiness, or other disease-specific symptoms; (2) the chronic use of psychotropic and/or vasoactive medications, including amphetamines, in patients with these disorders; and (3) delayed emergence from anesthesia (Mesa et al, 2000 ; Peláez et al, 2004 ; Burrow et al, 2005 ; Fischer et al, 2006 ; Ozkose et al, 2007 ; Staikou et al, 2007 ; Doyle and Wilkinson, 2008 ; Dahaba et al, 2009 ; Morimoto et al, 2011 ; Stoicea et al, 2014 ; Tzabazis et al, 2015 ; Aflaki et al, 2017 ). The concern regarding delayed emergence may be particularly relevant to a subgroup of patients with central disorders of hypersomnolence who demonstrate the presence of a positive allosteric modulator of gamma-aminobutyric acid Type A (GABA-A) receptors within spinal fluid (Rye et al, 2012 ).…”