Anaesthesia for patients with mood disorders
by
De Baerdemaeker L, Audenaert K, Peremans K.
Department of Anaesthesia
Department of Psychiatry and Medical Psychology,
Ghent University Hospital,
De Pintelaan 185, B-9000 Gent, Belgium
Department of Medical Imaging,
Faculty of Veterinary Sciences,
Salisburylaan 133,
B-9820 Merelbeke, Belgium.
Curr Opin Anaesthesiol. 2005 Jun;18(3):333-8.

ABSTRACT

PURPOSE OF REVIEW: Treatment of patients with mood disorders has changed over the past few years. It is not always clear how the anaesthesiologist has to incorporate these antidepressants and mood stabilizers in premedication or even how to anticipate any interaction with anaesthetic technique. RECENT FINDINGS: The older generation of antidepressants (tricyclic antidepressants, monoamine oxidase inhibitors) is seldom used nowadays. Actually, treatment with selective serotonin-reuptake inhibitors, serotonin noradrenalin-reuptake inhibitors, noradrenaline-reuptake inhibitor, noradrenergic and specific serotonin antidepressants, or noradrenaline- and dopamine-reuptake inhibitors is common practice. Combination with atypical antipsychotics and newer antiepileptics is suggested as an add-on therapy or as monotherapy, while lithium and valproate therapy is still the first choice in bipolar mood stabilization. Electroconvulsive therapy is still used in therapy-resistant forms of depression; however, the anaesthesia technique herein has been increasingly well described in the last years. Electroencephalogram-derived monitoring such as bispectral index (BIS) can be used as a tool to predict seizure duration. Intoxications with these newer agents are not infrequent and deserve specific attention. In particular, serotonin syndrome is a life-threatening condition that requires great care by the anaesthesiologist. The chronic use of antidepressants does affect the anaesthetized patient: hypotension, arrhythmias, changed thermoregulation, altered postoperative pain, differences in surgical stress response and postoperative confusion. However, it is advised to continue these drugs in the perioperative period. SUMMARY: Discontinuation of treatment with the new antidepressants in the perioperative period is not advised. Intoxication with the newer drugs appears to be safer. The anaesthesiologist must pay attention to serotonin syndrome. Electroconculsive therapy has gained renewed attention.

People
Injections
Anaesthesia
Adverse effects
Antidepressants
General anaesthetics
Obstetric anaesthesia
Molecular mechanisms
Inhalational techniques
Nitrous oxide: adverse effects
Parkinson's disease and anaesthetics
Anaesthesia: rivalries and discoveries
Consciousness, anaesthesia and anaesthetics
Anaesthetic effects on neurotransmitter uptake

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