Anesthetic concerns for patients on psychotropic agents

The incidence and prevalence of mental illness is expected to increase substantially in the next twenty years. There are two reasons for this increase: (1) the declining mortality rate of mentally ill individuals and (2) the increasing life span of persons with chronic illnesses and disabilities that are associated with psychological problems.' Many of these people are now seen in the operating room for a variety of procedures. Data reveals that at least 50% of emotionally and mentally disturbed individuals have a physical illness. 2 Not only must the anesthetist be able to deal with the patient's emotional state but he must also have knowledge about possible interactions between the psychoactive drugs and those drugs used in anesthesia. For any patient the possibility of surgery can be a frightening experience. The psychiatric patient may not be able to cope with his anxiety as well as other patients can. It is important to make these patients as comfortable and secure as possible in their new environment. A proper preoperative visit may be all that is necessary to help alleviate undue anxiety. If a preoperative medication is necessary, the anesthetist should know what type of condition the patient is being treated for and what medications the patient is receiving. Plans for the treatment of possible drug reactions, interactions and toxicity should always be established before the initiation of any kind of therapy. Psychotropic drugs in general profoundly affect central and peripheral neurotransmitter and ionic mechanisms. Hence, prior intake of these drugs is an important consideration in the management of the surgical patient. These patients frequently are taking phenothiazines, tricyclic antidepressants, monoamine oxidase (MAO) inhibitors or a combination of all three. In 1977, 20% of all prescriptions were for mood-altering drugs.8 Many of these people are not institutionalized, but live in the community and may not wish to talk about their medical history or the drugs that they are taking. It is especially important to establish a good rapport with these patients and to emphasize the confidentiality of the preoperative interview.