Abstract
Purpose
To investigate whether antidepressants administered to patients for chronic depression patients should be continued or discontinued before anesthesia.
Results
We studied 80 depressed patients who were scheduled to undergo orthopedic surgery under general anesthesia. The patients were divided randomly into two groups; patients in Group A (n = 40) continued antidepressants before surgery and patients in Group B (n = 40) discontinued antidepressants 72 hr before surgery. Two (5%) out of 40 patients in Group A and eight (20%) out of 40 patients in Group B had deterioration of depressive symptoms (P = 0.04). Delirium or confusion during the perioperative course occurred in five patients (13%) in Group A and in 12 (30%) in Group B (P = 0.05). There were no significant differences in incidence (5 vs 6%) of hypotension and arrhythmias during anesthesia between the two groups.
Conclusion
Antidepressants administered to depressed patients should be continued before anesthesia. Discontinuation of antidepressants did not increase the incidence of hypotension and arrhythmias during anesthesia, but increased symptoms of depression and delirium or confusion.
Résumé
Objectif
Vérifier si le traitement antidépresseur administré aux patients atteints de dépression chronique devrait être ou non interrompu avant i’anesthésie.
Méthode
Nous avons étudié 80 patients déprimés qui devaient subir une intervention orthopédique sous anesthésie généraie. Les patients ont été répartis au hasard en deux groupes : ceux du groupe A (n = 40) ont poursuivi ie traitement antidépresseur jusqu’à i’opération et ceux du groupe B (n = 40) l’ont interrompu 72 h avant.
Résultats
Deux (5%) patients du groupe A et huit (20%) du groupe B ont subi une détérioration des symptômes dépressifs (P = 0,04). Le déiire et !a confusion ont été observés chez cinq patients pendant ia période périopératoire (13%) chez les patients du groupe A et chez douze patients du groupe B (30%) ( P = 0,05). Il n’y a pas eu de différence intergroupe significative quant à l’incidence (5 vs 6 %) d’hypotension et d’arythmie pendant I’anesthésie.
Conclusion
Le traitement antidépresseur administré aux patients déprimés devrait se poursuivre avant I’anesthésie. Son arrêt n’augmente pas l’incidence d’hypotension ou d’arythmie pendant I’anesthésie, mais accentue les symptômes dépressifs, le délire ou la confusion.
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References
Scher CS, Anwar M. The self-reporting of psychiatric medications in patients scheduled for elective surgery. J Clin Anesth 1999; 11: 619–21.
Braverman B, McCarthy RJ, Ivankovich AD. Vasopressor challenges during chronic MAOI or TCA treatment in anesthetized dogs. Life Sci 1987; 40: 2587–95.
Anonymous. Drugs for psychiatric disorders. Med Lett Drugs Ther 1991; 33: 43–50.
Edwards RP, Miller RD, Roizen MF, et al. Cardiac responses to imipramine and pancuronium during anesthesia with halothane or enflurane. Anesthesiology 1979; 50: 421–5.
Glisson SN, Fajardo L, El-Etr AA Amitriptyline therapy increases electrocardiographic changes during reversal of neuromusclar blockade. Anesth Analg 1978; 57: 77–83.
Sprung J, Schoenwald PK, Levy P, Krajewski LP. Treating intraoperative hypotension in a patient on long-term tricyclic antidepressants: a case of aborted aortic surgery. Anesthesiology 1997; 86: 990–2.
Berggren D, Gustafson T, Eriksson B, et al. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesth Analg 1987; 66: 497–504.
Chung F, Meier R, Lautenschlager E, Carmichael FJ, Chung A General or spinal anesthesia: which is better in the elderly? Anesthesiology 1987; 67: 422–7.
Dilsaver SC, Coffman JA Antipsychotic withdrawal phenomena in the medical-surgical setting. Gen Hosp Psychiatry 1988; 10: 438–46.
Wong KC, Puerto AX, Puerto BA, Blatnick RA Influence of imipramine and pargyline on the arrhythmogenicity of epinephrine during halothane, enflurane or methoxyflurane anesthesia in dogs. Life Sci 1980; 27: 2675–8.
Janowsky EC, Risch C, Janowsky DS. Effects of anesthesia on patients taking psychotropic drugs. J Clin Psychopharmacol 1981; 1: 14–20
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washinton DC: Am Psychiatric Assoc 1994: 458–62.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–61.
Lnnouye SIC, van Dyck CHV, Alessi CA, Balkin S, Siegal AP, Horwitz RJ. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Internal Med 1990; 113: 941–8.
Cummins RQ Textbook of Advanced Cardiac Life Support. Dallas, American Heart Association, 1994.
Rosenthal JA American Heart Association recommendation for treating tricyclic antidepressant-induced hypotension (Letter). Anesthesiology 1997; 87: 1259–60.
Harding S, Jones RM Intercurrent medication. In: Aitkenhead AR, Jones RM (Eds.). Clinical Anaesthesia. New York: Churchill Livingstone Inc., 1996: 91–105.
Sumikawa K, Ishizaka N, Suzaki M Arrhthmogenic plasma levels of epinephrine during halothane, enflurane, and pentobarbital anesthesia in the dog. Anesthesiology 1983; 58: 322–5.
Murray AM, Levkoff SE, Wetle TT, et al. Acute delirium and functional decline in the hospitalized elderly patients. J Gerontol 1993; 48: M181–86.
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Kudoh, A., Katagai, H. & Takazawa, T. Antidepressant treatment for chronic depressed patients should not be discontinued prior to anesthesia. Can J Anesth 49, 132–136 (2002). https://doi.org/10.1007/BF03020484
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DOI: https://doi.org/10.1007/BF03020484