Pharmacology and Perioperative Considerations for Psychiatric Medications

Background: Psychotropic medications are being used increasingly as analgesics and for other off-label indications for patients with and without psychiatric conditions. While the pharmacology of most of these drugs is now known, their interaction with anesthetic drugs and implications of regular use are still relatively unclear. Objective: We discuss the pharmacology, side effects, and potential medication interactions with anesthetic agents of various commonly prescribed psychotropic medications and the current recommendations regarding the continuation of these medications during the patients' perioperative care. Method: A review of the current literature present on PubMed and Medline was conducted between the years 2000-2016. The reference lists of each selected article were also reviewed for additional sources of information. Conclusion: Psychotropic medications can be broadly divided into classes, which include antidepressants, antipsychotics, anxiolytics, mood stabilizers, and stimulants. Although most evidence suggests the continuation of these medications in the perioperative period, it is still important to determine how psychotropic medications interact with routinely used anesthetic agents and which medications should be continued and which should not be continued on an individualized basis for each patient.