Posted by JaclinHyde on April 9, 2006, at 23:03:12
In reply to off Parnate for surgery and MISERABLE, posted by Merci on April 8, 2006, at 13:20:58
Take this and print it out for your doctor to read.
"Do MAOI interact with anesthetic drugs?
MAOI inhibit microsomal enzymes, theoretically potentiating barbituates and opioids.80 Three cases of excessive barbiturate/opioid effects were reported from 1960 to 1970.80,84 Since then, numerous reports have described uneventful anesthetics using barbiturates and various opioids: remifentanil,89 alfen-tanil,89,90 sufentanil,91 fentanyl,80,81 hydromorphone91 and morphine80,81,81,85,89 for patients continuing to take MAOI. Other agents including propofol,90,92 ket-amine,93 midazolam,92 ketorolac,92 vecuronium,92 and atracurium92 have also been used safely. Severe hypertension on induction with etomidate and atracurium has occurred, although the patient’s blood pressure was 200/90 immediately prior to induction.94 Regional anesthesia has been performed without incident when hypotension was treated appropriately with volume and direct-acting sympathomimetics.80,81,95,96 Normal responses to most anesthetic agents can be expected (grade C).Is the continuation of MAOI associated with adverse outcomes?
Much of our understanding of the interactions between MAOI and anesthetic drugs comes from reports of isolated events in individual patients. A controlled prospective evaluation of 27 patients chronically treated with MAOI undergoing 36 anesthetics reported no adverse cardiovascular responses.95 Changes in blood pressure and heart rate were not significantly different from control patients without prior MAOI exposure. Anesthetic agents included sodium thiopental, etomidate, diazepam, succinylcholine, nitrous oxide, volatiles, pancuronium, morphine, spinal tetracaine, epidural bupivacaine, and phenylephrine.95 Similarly a review of a series of 32 orthopedic patients on MAOI who underwent 46 general anesthetics and five regional anesthetics for elective surgery found no adverse hemodynamic events.96 Agents used in this series included sodium thiopental, ketamine, volatiles, morphine and meperidine. Aside from sporadic case reports, the continued use of MAOI/RIMA has not been associated with adverse perioperative events when meperidine and indirect acting catecholamines are avoided (grade B).Conclusion – MAOI
Case reports of sporadic MAOI-related drug interactions prompted many to advise discontinuation of classic MAOI two to three weeks before surgery.80,84,95 Withdrawal of MAOI is not without risks. Many patients have severe depression refractory to other treatment and are at risk for life-threatening psychiatric illness. Acute exacerbation of depression with suicidal ideation has been reported after discontinuation of MAOI prior to elective cardiac surgery.97 There is no literature specifically concerning MAOI and ambulatory anesthesia. MAOI-related drug interactions are possible and have been reported; however, patients continuing to take either classic or selective MAOI remain suitable candidates for ambulatory anesthesia if meperidine, cocaine and indirect-acting catecholamines are avoided."
The link is http://www.cja-jca.org/cgi/content/full/51/8/782#SEC16 near the bottom of the page.
JH
poster:JaclinHyde
thread:630581
URL: http://www.dr-bob.org/babble/20060408/msgs/631234.html