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Cornell C. CORR Insights®: What is the Association Between Clinically Diagnosed Psychiatric Illness and Total Joint Arthroplasty? A Systematic Review Evaluating Outcomes, Healthcare Use, and Patient-reported Outcome Measures. Clin Orthop Relat Res 2023; 481:965-966. [PMID: 36455102 PMCID: PMC10097576 DOI: 10.1097/corr.0000000000002500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Charles Cornell
- Orthopaedic Surgeon, Hospital for Special Surgery, New York, NY, USA
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Fanelli D, Weller G, Liu H. New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations. Neurol Int 2021; 13:497-509. [PMID: 34698218 PMCID: PMC8544373 DOI: 10.3390/neurolint13040049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 01/12/2023] Open
Abstract
Serotonin-norepinephrine reuptake inhibitors (SNRIs) inhibit the presynaptic neuronal uptake of serotonin and norepinephrine and prolong the effects of the monoamines in the synaptic cleft within the central nervous system, leading to increased postsynaptic receptor activation and neuronal activities. Serotonin-norepinephrine reuptake inhibitors can have multiple clinical indications, including as the first-line agents for the management of depression and anxiety, and as analgesics in the treatment of chronic pain. The effects of reuptake inhibition of norepinephrine and serotonin are often dose-dependent and agent-dependent. There are five FDA-approved serotonin-norepinephrine reuptake inhibitors (desvenlafaxine, duloxetine, levomilnacipran, milnacipran and sibutramine) currently being marketed in the United States. As the COVID-19 pandemic significantly increased the incidence and prevalence of anxiety and depression across the country, there are significantly increased prescriptions of these medications perioperatively. Thus, anesthesiologists are more likely than ever to have patients administered with these agents and scheduled for elective or emergency surgical procedures. A thorough understanding of these commonly prescribed serotonin-norepinephrine reuptake inhibitors and their interactions with commonly utilized anesthetic agents is paramount. There are two potentially increased risks related to the continuation of SNRIs through the perioperative period: intraoperative bleeding and serotonin syndrome. SNRIs have some off-label uses, more new indications, and ever-increasing new applications in perioperative practice. This article aims to review the commonly prescribed serotonin-norepinephrine reuptake inhibitors and the current clinical evidence regarding their considerations in perioperative anesthesia and analgesia.
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The effectiveness of BIS monitoring during electro-convulsive therapy: A systematic review and meta-analysis. J Clin Anesth 2019; 58:100-104. [DOI: 10.1016/j.jclinane.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
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Saraghi M, Golden L, Hersh EV. Anesthetic Considerations for Patients on Antidepressant Therapy - Part II. Anesth Prog 2018; 65:60-65. [PMID: 29509514 DOI: 10.2344/anpr-65-01-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Millions of patients take antidepressant medications in the United States for the treatment of depression or anxiety disorders. Some antidepressants are prescribed off-label to treat problems such as chronic pain, low energy, and menstrual symptoms. Antidepressants are a broad and expansive group of medications, but the more common drug classes include tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors. A miscellaneous or "atypical" category covers other agents. Some herbal supplements that claim to have antidepressant activity will also be discussed. Part I of this series reviewed antidepressant pharmacology, adverse effects, and drug interactions with adrenergic agonists. In part II, drug-drug interactions with sedation and general anesthetics, bleeding effects, and serotonin syndrome will be discussed.
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Affiliation(s)
- Mana Saraghi
- Director, Dental Anesthesiology Residency Program, Jacobi Medical Center, Bronx, New York
| | - Leonard Golden
- Chair, Department of Anesthesiology, Jacobi Medical Center, Bronx, New York
| | - Elliot V Hersh
- Director, Division of Pharmacology and Therapeutics; Professor, Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
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Saraghi M, Golden LR, Hersh EV. Anesthetic Considerations for Patients on Antidepressant Therapy-Part I. Anesth Prog 2018; 64:253-261. [PMID: 29200376 DOI: 10.2344/anpr-64-04-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Millions of patients take antidepressant medications in the United States for the treatment of depression or anxiety disorders. Some antidepressants are prescribed off-label to treat problems such as chronic pain, low energy, and menstrual symptoms. Antidepressants are a broad and expansive group of medications, but the more common drug classes include tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors. A miscellaneous or "atypical" category covers other agents. Some herbal supplements that claim to have antidepressant activity will also be discussed. In Part I of this review, antidepressant pharmacology, adverse effects, and drug interactions with adrenergic agonists will be discussed. In part II, drug interactions with sedation and general anesthetics will be reviewed. Bleeding effects and serotonin syndrome implications in anesthetic practice will also be highlighted.
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Affiliation(s)
- Mana Saraghi
- Director, Dental Anesthesiology Residency Program, Jacobi Medical Center, Bronx, New York
| | - Leonard R Golden
- Chairman, Department of Anesthesiology, Jacobi Medical Center Bronx, New York
| | - Elliot V Hersh
- Professor, Pharmacology Director, Division of Pharmacology and Therapeutics, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia
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Abstract
ABSTRACT
Monoamine oxidase (MAO) inhibitors are frequently used for multidrug-resistant major depression, which is emerging as an epidemic in the modern era. Anesthesia during chronic use of MAO inhibitors is a matter of debate because of increased risk of drug interactions with various anesthetic drugs. Cardiac disorders contribute to perioperative and postoperative complications. Recent studies illustrate the safety of anesthesia without discontinuation of MAO inhibitors if sympathetic homeostasis is maintained and known drug interactions are avoided. In this case study, a 72-year-old male psychiatric patient on permanent treatment with tranylcypromine (30 mg/day) was admitted for bipolar hemiarthroplasty. After complete aseptic precautions, spinal anesthesia was achieved by 12.5 mg 0.5% heavy bupivacaine and 30 μg clonidine intrathecally. The anesthetic effect was adequate, but surgery was not completed timely and the effect of spinal anesthesia was weaned off, so general anesthesia was given and surgery was completed. There was no perioperative or postoperative complication. In conclusion, general or regional anesthesia for noncardiac surgery without discontinuation of MAO inhibitors may be safe after careful preoperative evaluation of the patient.
How to cite this article
Krishan G, Singh RP, Agrawal M, Agrawal R. Anesthesia for a Patient on Monoamine Oxidase Inhibitors. Int J Adv Integ Med Sci 2016;1(2):81-83.
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Golembiewski J. Antidepressant pharmacology and perioperative implications. J Perianesth Nurs 2014; 29:327-9. [PMID: 25062579 DOI: 10.1016/j.jopan.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
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Soehle M, Kayser S, Ellerkmann R, Schlaepfer T. Bilateral bispectral index monitoring during and after electroconvulsive therapy compared with magnetic seizure therapy for treatment-resistant depression. Br J Anaesth 2014; 112:695-702. [DOI: 10.1093/bja/aet410] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Hwang W. Medications or food before anesthesia to note taking. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2014. [DOI: 10.5124/jkma.2014.57.10.832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wonjung Hwang
- Department of Anesthesiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Fixley JE, Tadel MC. Psychiatric Conditions. Perioper Med (Lond) 2011. [DOI: 10.1007/978-0-85729-498-2_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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[Perioperative management of long-term medication]. Internist (Berl) 2010; 52:89-98. [PMID: 21088954 DOI: 10.1007/s00108-010-2755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and/or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.
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Stanford SC, Stanford BJ, Gillman PK. Risk of severe serotonin toxicity following co-administration of methylene blue and serotonin reuptake inhibitors: an update on a case report of post-operative delirium. J Psychopharmacol 2010; 24:1433-8. [PMID: 19423610 DOI: 10.1177/0269881109105450] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a previous case report, published in this journal, we described a postoperative delirium in a patient during recovery from parathyroidectomy. We noted that the delirium resembled serotonin toxicity and that the patient had been taking paroxetine until 2 days before surgery. We offered several tentative explanations for this event, including an adverse interaction between paroxetine and other agent(s) used in the course of the anaesthesia. Recent developments in characterisation of serotonin toxicity have prompted us to re-examine the clinical details surrounding this life-threatening event. It is now known to be important that the patient was given methylene blue, pre-operatively, to enable visualisation of the parathyroid glands. Methylene blue has been found to be a potent inhibitor of monoamine oxidase (MAO), and several cases of serotonin toxicity have been reported recently following its administration. All these cases are consistent with the well-known risk of serotonin toxicity when drugs that augment serotonergic transmission are given in combination with an MAO inhibitor. Methylene blue is used in a variety of surgical settings as well as for treatment of various types of hypotensive shock and methemoglobinaemia. It is also being studied for treatment of Alzheimer's disease and malaria. In this paper, we outline the pharmacology of methylene blue and the aetiology of serotonin toxicity to help prevent further unintentional co-administration of drugs that risk precipitating this life-threatening drug interaction.
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Affiliation(s)
- S C Stanford
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
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Acute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes. Curr Opin Anaesthesiol 2009; 22:627-33. [DOI: 10.1097/aco.0b013e32833037d2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gokcinar D, Karabeyoglu I, Ucar H, Gogus N. Post-operative nystagmus and anisocoria due to serotonin toxicity? Acta Anaesthesiol Scand 2009; 53:694-5. [PMID: 19419379 DOI: 10.1111/j.1399-6576.2009.01926.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Godeiro-Júnior CO, Oliveira ASB, Felício AC, Barros N, Gabbai AA. Peroneal nerve palsy due to compartment syndrome after facial plastic surgery. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:826-9. [DOI: 10.1590/s0004-282x2007000500018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 05/23/2007] [Indexed: 05/25/2023]
Abstract
A 25-year-old white man, right after bilateral rhytidoplasty, presented with agitation, necessiting use of haloperidol. Some hours after, he developed severe pain in his legs and a diagnosis of neuroleptic malignant syndrome (NMS) was considered. Even with treatment for NMS he still complained of pain. A diagnosis of lower limb compartment syndrome (CS) was done only 12 hours after the initial event, being submitted to fasciotomy in both legs, disclosing very pale muscles, due to previous ischemia. This syndrome was not explained only by facial surgery, his position and duration of the procedure. It can be explained by a sequence of events. He had a history of pain in his legs during physical exercises, usually seen in chronic compartment syndrome. He used to take anabolizant and venlafaxine, not previously related, and the agitation could be related to serotoninergic syndrome caused by interaction between venlafaxine and haloperidol. Rhabdomyolisis could lead to oedema and ischmemia in both anterior leg compartment. This report highlights the importance of early diagnosis of compartment syndrome, otherwise, even after fasciotomy, a permanent disability secondary to peripheral nerve compression could occur.
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Hadi I, Morley-Forster PK, Dain S, Horrill K, Moulin DE. Brief review: Perioperative management of the patient with chronic non-cancer pain. Can J Anaesth 2006; 53:1190-9. [PMID: 17142653 DOI: 10.1007/bf03021580] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Both opioid and non-opioid medications are being utilized increasingly in the treatment of chronic non-cancer pain, and the number of surgical patients receiving large regular doses of opioids is ever-expanding. The perioperative pain control of these patients is often challenging, and is broadening the role of the anesthesiologist as 'perioperative physician'. These patients need to be identified before surgery to plan optimal pain control postoperatively. The purpose of this review is to provide an update on the important considerations in managing the chronic non-cancer pain patient receiving high dose opioids and other adjunctive medications/analgesics. SOURCE English language articles published between June 1980 and May 2006 were identified by a computerized Medline search using keywords (1/2)chronic pain(1/2), (1/2)opioid dependent(1/2) and (1/2)perioperative(1/2). This same search strategy was repeated and updated using both Medline and Embase. All relevant publications were retrieved and their bibliographies were scanned for additional sources. PRINCIPAL FINDINGS Although an increasingly common problem for the acute pain service, there is very little published on this topic. Key points include the concept of opioid equivalency, tolerance, the role of adjunctive medications, and the need for good communication between the surgical team, the acute pain service and the patient who is often anxious about the upcoming procedure due to previous unpleasant experiences with poor pain control in hospital. CONCLUSION Clinical care of the opioid-dependent patient in the perioperative period can be a daunting task. Education to all staff involved in this area needs to be enhanced to improve outcome and patient satisfaction.
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Affiliation(s)
- Ibrahim Hadi
- Department of Anesthesia and Perioperative Medicine, Interdisciplinary Pain Program, University of Western Ontario, London, Ontario, Canada
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