Consensus statement on preoperative management of psychiatric medications
USA: A recent study published in Mayo Clinic Proceedings reports a consensus statement for preoperative management of medications for psychiatric diseases by the Society for Perioperative Assessment and Quality Improvement.
There is a lack of guidelines for preoperative management of psychiatric medication that leads to variation in care and potential for perioperative complications and surgical procedure cancellations on the day of surgery. Considering this, Adriana D. Oprea, Department of Anesthesiology, Yale School of Medicine, New Haven, CT, and the team aimed to provide recommendations to clinicians regarding preoperative psychiatric medication management.
The authors' group identified several categories of drugs including mood stabilizers, antidepressants, antipsychotics, anxiolytics, and attention deficit hyperactivity disorder medications. For each medication/medication class literature searches and review of primary and secondary data sources were performed.
- Consensus Recommendations for Benzodiazepines: Take preoperatively, including the day of surgery (DOS).
- Consensus Recommendation for selective serotonin reuptake inhibitors (SSRIs): Take preoperatively, including DOS.
- Consensus Recommendation for serotonin-norepinephrine reuptake inhibitors (SNRIs): Take preoperatively, including DOS.
- Consensus Recommendation for tricyclic antidepressants (TCAs): Take preoperatively, including DOS.
- Consensus Recommendation for monoamine oxidase inhibitors (MAOIs): Take preoperatively, including DOS, and alert the anesthesiologist assigned to the patient. Alternatively, discontinue for 10 to 14 days, under the psychiatrist's guidance.
- Consensus Recommendation for Atypical Antidepressants: Take preoperatively, including DOS.
- Consensus Recommendation for Anticonvulsants Used as Mood Stabilizers: Take preoperatively, including DOS.
- Consensus Recommendation for Lithium: For minor procedures, take preoperatively, including DOS.
- Consensus Recommendation for Lithium: For major procedures, hold for 72 hours preoperatively.
- Consensus Recommendation for Antipsychotics: Take preoperatively, including DOS.
- Consensus Recommendation for Amphetamines: Hold on DOS.
- Consensus Recommendation for Guanfacine: Take preoperatively, including DOS.
"This consensus statement provides a framework for clinicians, based on multispecialty expert opinion and best practices," wrote the authors. "It summarizes important anesthetic and common perioperative medication interactions and provides consensus recommendations based on the limited evidence available."
"Hopefully, this clinical consensus guideline can improve patient care by providing guidance regarding the management of psychiatric medications in the perioperative setting," they concluded.
Reference:
"Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement," was published in the journal Mayo Clinic Proceedings.
