Monoamine oxidase inhibitors and anaesthesia. A review

There has been a recent renewal of interest in the use of monoamine oxidase inhibitors in psychiatry. The concurrent administration of anaesthetic agents, particularly narcotic analgesics, is often a cause for concern. Although many monoamine oxidase inhibitor-drug interactions have been reported, in practice it is only the interaction with pethidine which has led to fatalities. What is not appreciated is that the monoamine oxidase inhibitor-pethidine interaction has two distinct forms-"excitatory" and "depressive". It is this lack of appreciation that has led to much confusion when dealing with patients taking monoamine oxidase inhibitors.