[General anesthesia and long term psychotropic treatments]

Area of Science:

• Anesthesiology
• Psychiatry
• Pharmacology

Background:

• Anesthesiologists frequently request psychotropic medication cessation before surgical procedures.
• This request often lacks differentiation between various psychotropic drug classes.
• Certain psychotropic agents, like MAO inhibitors, pose risks upon abrupt withdrawal.

Purpose of the Study:

• To review the psychiatric risks associated with discontinuing psychotropic treatment before surgery.
• To evaluate the safety of continuing psychotropic medications during anesthesia, particularly electroconvulsive therapy (ECT).

Main Methods:

• Literature review on psychiatric risks of psychotropic drug withdrawal.
• Analysis of safety data from 8,210 ECT procedures performed under general anesthesia.
• Comparison of outcomes between ECT with and without prior psychotropic withdrawal in 5,688 cases.

Main Results:

• Psychiatric risks associated with psychotropic withdrawal are significant and warrant consideration.
• No severe accidents were recorded in 8,210 ECT procedures.
• In 5,688 of these ECT cases, psychotropic medications were not withdrawn without adverse events.

Conclusions:

• Routine withdrawal of all psychotropic medications before surgery may not be necessary and can pose psychiatric risks.
• Continuing certain psychotropic medications, including antidepressants, neuroleptics, and minor tranquilizers, appears safe during anesthesia.
• Further consideration of drug-specific risks and benefits is crucial for perioperative psychiatric management.