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Review Article

RMJ. 2016; 41(2): 241-249


Perioperative management of psychotropic drugs: A literature review

Bong Ju Lee.

Abstract
The perioperative management of psychotropic drugs is associated with unexpected results of drug–drug interactions, as well as increased risk of exacerbation of psychiatric symptoms and withdrawal symptoms after psychotropic discontinuation. To find optimal guidelines for the management of psychotropic drugs in the perioperative period, this review of management of psychotropic drugs associated with surgery was conducted. A total of 26 articles, including 14 review and 12 original articles, describing the relationship between management of psychotropic drugs with surgery published in English before February 2015 were selected and reviewed. The published information suggests that the decision whether to stop a psychotropic drug prior to surgery should be individualized, taking into account the extent of surgery, the patients’ conditions and the risks of discontinuation of psychotropic drugs. The risks and benefits of psychotropic drug use should be weighed in all patients undergoing surgery. For most psychotropic drugs, the risks of discontinuation usually exceed the risks of continuing them. Discontinuing of monoamine oxidase inhibitors before surgery is recommended, but discontinuing lithium, tricyclic antidepressants, and serotonergic antidepressants should be considered according to situation.

Key words: Psychotropic drugs, drug interactions, perioperative care



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