[Perioperative use of psychotropic drugs; advice based on casuistic and 'expert-based medicine']

Little scientific evidence is available on the continuation of psychotropic drugs in the perioperative period. Clinicians often have to rely on case reports and small case series. However, case reports of rare events, such as life-threatening interactions between psychotropic drugs and anaesthetics, do not provide reliable data on the frequency of such events and may lead to a rather defensive approach. Recommendations were published recently based on expert opinion from a multidisciplinary group. This proposal could be used for the development of an official, evidence-based guideline on the perioperative use of psychotropic drugs. The quality of such a guideline would be improved by prospective cohort studies that compare events in patients who discontinue psychotropic medication with those in patients who continue medication for fear of severe withdrawal symptoms.