Korean J Psychosom Med.  2024 Dec;32(2):53-63. 10.22722/KJPM.2024.32.2.53.

Considerations for Use of Psychotropic Drugs in the Perioperative Period

• Yoon HJ

• KMID: 2564518
• DOI: http://doi.org/10.22722/KJPM.2024.32.2.53

Abstract

Recently, a number of patients with psychiatric disorders have received surgical treatments due to physical diseases. Patients who use psychotropic drugs and require surgery have increased perioperative complications because of drug-drug interactions, risk of withdrawal symptoms, and recurrence or relapse of psychiatric disorders. Hence, perioperative management of psychotropic medications is crucial for improving the postoperative outcomes. This paper attempts to provide an overview of considerations and recommendations for perioperative use of major psychotropic drugs. Physical health-related factors such as the American Society of Anesthesi- ologist Physical Status Classification System are considered key factors in the decision process for the use of psychotropic drugs in the perioperative period. For patients who are healthy or with mild physical disease, most psychotropic drugs are recommended to be maintained during the perioperative period to avoid relapse of psychiatric condition. However, clozapine and lithium need to be discontinued before surgery due to serious drug-drug interactions and potential toxicity. For patients who have severe physical or mental disease with functional impairment, optimal use of psychotropic drugs should be individualized to balance the risk of maintaining psychotropics in the perioperative period versus the risk of relapse of the underlying psychiatric condition if they are discontinued before surgery. Development of the guidelines for perioperative use and management of psychotropics based on recent research and expert opinions can contribute to improving the quality of patient care in the perioperative setting.

Keyword

Psychotropic drugs; Perioperative period; Drug interactions; Surgery