WIDESPREAD PSYCHIATRIC DRUG USE POINTS TO NEED TO EXPLORE INTERACTIONS WITH ANESTHESIA
Corey S. Scher, M.D. ASA ANNUAL MEETING
FOR RELEASE: October 19, 1998
CONTACT: Denise M. Jones Monday, Philip S. Weintraub, (847) 825-5586
Oct. 17-21 (407) 248-5010
ORLANDO -- Anesthesiologists routinely ask patients to tell them what medications they are taking before surgery. This information helps them plan safe, effective anesthesia tailored to patients' individual needs. Yet some patients are not reporting their use of psychiatric drugs, which are among a growing class of drugs being prescribed or made available over the counter. Studies into the interaction of these drugs with anesthesia are critical, researchers at the American Society of Anesthesiologists annual meeting said.
In the first study of its kind, researchers at Tulane University School of Medicine in New Orleans found that nearly half of patients over the age of 21 scheduled for elective surgery were taking one or more of these medications. They include the full range of prescription and nonprescription psychotropic, or antidepressant, drugs -- everything from Valium to Prozac to the herbal product, St. John's Wort.
"The finding has significance because both psychiatric drugs and anesthetic drugs temporarily alter brain chemistry and cell membranes in the central nervous system, but little is known about how these two groups of drugs interact," anesthesiologist Corey S. Scher, M.D., said.
"The rapid influx of new psychiatric drugs on the market over the past 10 years underscores the need to understand the relationships between these two groups of medications," he said. "If both types of drugs work in similar ways -- and we believe they do -- the impact on anesthesia needs to be defined."
In the meantime, patients should be sure to tell their anesthesiologist during the preoperative assessment if they are taking any of these drugs. "Not doing so is like a diabetic not revealing that he or she is on insulin," Dr. Scher said. There is also considerable overlap between the two groups of drugs. Anxiety relievers, called benzodiazepines, for example, are commonly used as sedatives for many surgical procedures. Anesthesiologists will give less of this drug to surgical patients who have been taking it on a regular basis, he said.
In the Tulane study, 169 surgical patients were given a survey that asked them to circle those medications they were taking in addition to their nonpsychiatric medications. Administered following the preoperative examination, the survey included 33 drugs known to affect the central nervous system, including antidepressants, antipsychotics, benzodiazepines, lithium and over-the-counter drugs known to affect mood, such as insomnia remedies containing melatonin. Patients were not asked to reveal why they were taking the medications.
Forty-three percent of patients admitted to taking one or more of the listed drugs. Of those, 35 percent were on benzodiazepines, 19 percent were on combination therapies, and 11 percent were on antipsychotics, lithium or over-the-counter drugs.
"From this survey, we know the number of patients on psychotropic drugs is high, and we suspect there are other patients who did not admit to taking these medications on the survey," Dr. Scher said. "It is possible that more people take psychiatric drugs than any other class of medications. There has to be some influence of these drugs on anesthesia, but we don't know what it is."
The researchers are now studying the relationship between anesthesia and postoperative depression in patients who are and are not taking psychiatric drugs, he said.
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