Implications on the perioperative management of psychotropic medications

Potentially dangerous interactions between psychotropic medications and medicines frequently used in anesthesia pose substantial risks regarding perioperative care. We aimed to review the recommendations of perioperative psychotropic medication management and to discuss potential interactions of the frequently used psychotropic drugs with anesthetic agents. PubMed/MEDLINE and Scopus databases were searched for the review articles reporting data on the perioperative management of psychotropic medications. Considering the heterogeneity of the included studies, a narrative approach to synthesis was conducted. The recommendations were summarized in the final selection of studies and categorized according to the main side effects, drug interactions, and anesthetic implications for perioperative management for each psychotropic drug category: antidepressants, antipsychotics, mood stabilizers, anxiolytics, and stimulants. Of the 12,569 identified citations, 11 articles were included in the narrative review. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, antipsychotics, antiepileptic mood stabilizers, and benzodiazepines are generally recommended to be continued perioperatively. The decision to maintain or adjust monoamine oxidase inhibitors or psychostimulants should be carefully individualized, considering the patient's overall health status and the potential for drug interactions with specific anesthetic agents. Discontinuation of lithium 72 hours before major surgery is recommended. For the effective management of psychotropic medications perioperatively, a multidisciplinary case-based evaluation is recommended to provide adequate care. Close collaboration of anesthesiology and surgical teams with mental health professionals is vital to ensure patient safety and optimal outcomes.