[Preoperative evaluation, preparation and prognosis in depressed patients]

Depressed patients have some problems before, during and after anesthesia such as hypotension, and torsade de pointes during anesthesia, postoperative confusion, serotonin toxicity, increased intraoperative bleeding by selective serotonin reuptake inhibitors. Depressed patients treated by antidepressants have decreased plasma cortisol and interleukin-6 response to surgery and are more at risk for developing postoperative confusion, that is associated with abnormal cortisol response to surgery and more frequent in patients discontinued antidepressants 72 hours before surgery. Depressed patients treated by antidepressants have high postoperative pain score, that depend on their depressed state. A small-dose of ketamine improves postoperative depressive state and relieves postoperative pain in depressed patients and is a suitable anesthetic for depressed patients. As the anesthetic management in depressed patients is becoming increasingly, anesthesiologists should be familiar with medical illness, abnormal response to surgery in depressed patients and must learn their perioperative management.