- Anaesthesia and psychoactive drugs
- Psychoactive drugs
- Antidepressants
- TCA
- Prevent reuptake of NA and serotonin
- Also have anti-muscarinic, antihistamine and anti-α1 effects
- Reduce seizure threshold especially with tramadol
- Potentiation with indirect acting sympathomimetics
- Consider stopping on an individual basis
- SSRIs
- Risk of precipitating serotonin syndrome with tramadol
- Hyperreflexia, agitation and hyperthermia seen
- Interfere with codeine metabolism so less effective
- Increased risk of bleeding with NSAIDs
- Considered safe to continue these perioperatively
- MAOIs
- Type A has preference for NA and serotonin
- Type B has preference for tyramine and phenylethylamine
- Antagonism of type A has the antidepressant effect
- Risk of hypertensive crisis especially with indirect actions sympathomimetics
- Irreversible MAOIs are stopped 2/52 prior to surgery
- Reversible ones are stopped on day prior to surgery
- Psychoactive drugs
- Antipsychotics
- Typical
- Have anti-dopaminergic, anti-histamine, anti-α1 and anti-muscarinic side effects
- Neuroleptic malignant syndrome can occur with hyperthermia, autonomic dysfunction and muscle rigidity.
- Atypical
- Lower (I) of extra pyramidal side effects
- Weight gain is commonly seen
- Mood stabilisers
- Lithium
Link:Lithium
- Stop 24hrs before surgery
- Prolongation of NMBDs
- Carbamazepine & valproate
- Valproate can cause bleeding post-op
- Carbamazepine induces p450 and aminosteroids are shortened in their action
- Carbamazepine also causes blood dyscrasias
- Anxiolytics
- Benzodiazepines most commonly used
- Beware withdrawal if on these chronically
- Continue perioperatively
- CEACCP
Link:ceaccp.oxfordjournals.org/content/10/6/177.full.pdf