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Canadian Journal of Anesthesia, Vol 12, 121-128, Copyright © 1965 by Canadian Anesthesiologists' Society

Potential Hazards of Psychoactive Drugs in Association with Anaesthesia

LEONARD C JENKINS BA, MD, CM, FRCP(C)1 and HORACE B GRAVES BA, MD, C.M, FRCP(C)1

1 Department of Surgery (Sub-section Anaesthesiology), Vancouver General Hospital, and the Faculty of Medicine, University of British Columbia, Vancouver, BC

In recent years psychoactive (antidepressant) drugs have been found useful in the treatment of both psychotic and psychoneurotic depression. The use of these drugs appears to be increasing, for they have been advocated in the treatment of angina pectoris, hypertension, and rheumatoid arthritis as well Thus, not only the psychotic patient on these drugs receiving thiopentone and succinylcholine for E C T presents to the anaesthetist, but also a wide variety of surgical patients may have been exposed to these drugs.

Pharmacologically, the antidepressants may be classified into two main groups (1) compounds which inhibit the enzyme monoamine-oxidase (2) compounds which do not inhibit the enzyme monoamine-oxidase.

The majority of the psychoanaleptics in current use are monoamine-oxidase inhibitors. By virtue of their ability to inhibit mopoamine-oxidase, there are increased levels of brain serotonin and/or norepinephrine, with resultant psychoactive effects. But the concentration of these biologically active amines not only appears to be increased at central sites but may also be elevated at peripheral autonomic synaptic and effector areas, providing a hazardous setting for subsequently administered anaesthetics. Four representative patients illustrate that hypotension, hypertensive crises, hyperthermia, convulsions, coma, and poteniation of atropine, corticosteroids, and Arfonad have all been observed as untoward reactions when anaesthesia 01 anaesthetic agents are given to patients on psychoactive drugs.

Management of these reactions is primarily supportive Caution must be used in the administration of vasopressors (norepinephrine) or adrenergic blockers (phentolamine) in the treatment of hypotensive or hypertensive reactions, respectively. Avoidance of these reactions is desirable Therefore a high index of awareness of the hazards that these drugs present in association with anaesthesia and caie to ascertain whether the patient is or has been taking these drugs during the 21 days prior to anaesthesia seem imperative.

Note:

Presented at the Canadian Anaesthetists' Society Annual Meeting, Montebello, Quebec, May 1964






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Copyright © 1965 by the Canadian Anesthesiologists' Society.