MAO inhibitors and coronary artery surgery: a patient death

Area of Science:

• Anesthesiology
• Pharmacology
• Critical Care Medicine

Background:

• Monoamine oxidase inhibitors (MAOIs) are associated with potential cardiovascular instability.
• Coronary artery surgery necessitates careful anesthetic management due to potential hemodynamic fluctuations.

Observation:

• A patient on MAOIs received fentanyl and midazolam for coronary artery surgery without immediate complications.
• Postoperatively, the patient experienced severe hypertension, hyperthermia, shivering, and refractory hypotension.

Findings:

• The patient's adverse postoperative events, including death, occurred in the context of MAOI use.
• While pulmonary embolism and sepsis were considered, the role of MAOIs in the fatal outcome is suspected.
• Few cases report fentanyl use with MAOIs, and animal-animal and human-animal responses differ.

Implications:

• MAOIs may significantly complicate anesthetic management and postoperative care, particularly in surgeries requiring catecholamines.
• Discontinuation of MAOIs prior to elective surgery is advisable when feasible.
• Further research is needed to elucidate the interaction between MAOIs, anesthetics, and surgical stress.