Anaesthetic management of labour and delivery in a woman taking long-term MAOI

Pavy, T. J. G.; Kliffer, A. P.; Douglas, M. Joanne

doi:10.1007/bf03011881

Cited by 20 publications

(7 citation statements)

References 10 publications

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“…Midazolam and other benzodiazepine drugs are discussed as being safe with MAO-inhibitors and this was confirmed in the present patient [12]. In agreement with the literature, careful establishment of the block and careful intravenous fluid loading for prophylaxis of hypotension were applied [19,29]. No direct sympathomimetics were required.…”

Section: Case Report With Discussionsupporting

confidence: 81%

“…No direct sympathomimetics were required. Phenylephrine was used by other therapists for perioperative hypotension in epidural anesthesia [19,30], however, it was suggested that phenylephrine exhibits partly indirect sympathomimetic activity and may be better substituted by norepinephrine [29]. An interaction of phenelzine and selegilin with indirect sympathomimetic ephedrine was reported for spinal anesthesia with blood pressure of 245/125 mmHg and 240/120 mmHg, respectively [45].…”

Section: Case Report With Discussionmentioning

confidence: 99%

“…El-Ganzouri et al [19] described three cases of spinal and epidural anesthesia during long-term treatment with MAO-inhibitors: removal of the tibial plate (12 mg tetracaine 1%, morphine), total gastrectomy (13 ml bupivacaine 0.5%, thiopental, succinylcholine, N 2 O/isoflurane, morphine), and transurethral prostate resection (10 mg tetracaine 1%, morphine). Management of labor over 14 hours (bupivacaine 0.25%) and subsequent successful Caesarean section with epidural anesthesia (bupivacaine 0.5%, morphine) was described for a 25-year-old pregnant woman taking phenelzine [29]. Epidural anesthesia (15 ml bupivacaine 0.5%) with general anesthesia (fentanyl, thiopentone, vecuronium, isoflurane) for an abdominal hysterectomy was conducted in a 70-yearold patient during long-term moclobemide therapy, a reversible MAO-A-inhibitor [30].…”

Section: Reports Of Continuous Maoinhibitors During Anesthesia/ Analgmentioning

confidence: 99%

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Antidepressant treatment with MAO-inhibitors during general and regional anesthesia: A review and case report of spinal anesthesia for lower extremity surgery without discontinuation of tranylcypromine

Krings-Ernst¹,

Ulrich²,

Adli

2013

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Monoamine oxidase-(MAO)-inhibitors are a treatment of last resort in treatment resistant depression, which is regarded as a condition of increased psychiatric risk. General and regional anesthesia for elective surgery during use of long-term MAO-inhibitors remains a matter of debate because of an increased risk of drug interactions and decreased sympathetic stability. A series of case reports and new comparative studies reveal the safety of anesthesia/analgesia in non-cardiac surgery without discontinuation of the MAO-inhibitor if best effort is made for maintenance of sympathetic homeostasis and if known drug interactions are avoided. Very few reports with severe adverse incidents have been noted. Severe cardiovascular morbidity, a contraindication of MAO-inhibitors, probably contributed to peri- and postoperative complications. According to new studies, the risk of pharmacokinetic drug interactions is lower for tranylcypromine than for phenelzine. In the present case, a 66-year-old psychiatric patient on permanent treatment with 20 mg/day tranylcypromine was admitted for forefoot surgery. Anesthetic premedication consisted of 7.5 mg oral midazolam. Intravenous midazolam (0.5 mg) was dispensed for intraoperative sedation. After local anesthesia of the puncture site with 30 mg isobar prilocaine, spinal anesthesia was achieved by a single shot of 13.5 mg hyperbar bupivacaine (0.5%) intrathecally. Postoperative regional and general analgesia were accomplished by a peripheral nerve block with 50 mg isobar bupivacaine as well as oral etoricoxib and oxycodone. No peri- or postoperative complications were encountered. It is concluded that general or regional anesthesia for noncardiac surgery without discontinuation of MAO-inhibitor treatment may be a safe intervention after careful evaluation of an individual's perioperative and psychiatric risk. The increased psychiatric risk in patients treated with MAO-inhibitors outweighs the increased, however manageable, perioperative risk from continuing treatment during surgery.

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Section: Case Report With Discussionsupporting

confidence: 81%

Section: Case Report With Discussionmentioning

confidence: 99%

Section: Reports Of Continuous Maoinhibitors During Anesthesia/ Analgmentioning

confidence: 99%

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Antidepressant treatment with MAO-inhibitors during general and regional anesthesia: A review and case report of spinal anesthesia for lower extremity surgery without discontinuation of tranylcypromine

Krings-Ernst¹,

Ulrich²,

Adli

2013

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“…No maternal or fetal adverse complications were noted in 2 women taking phenelzine throughout pregnancy. 35,36 Unlike the tricyclics, fluoxetine therapy does not result in maternal sedative, anticholinergic, hypotensive actions, and cardiotoxicity. Compared with tricyclics, serious acute reactions are less likely after large doses.…”

Section: Depressionmentioning

confidence: 99%

Use of Psychoactive Medication During Pregnancy and Possible Effects on the Fetus and Newborn

2000

Pediatrics

122

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Psychoactive drugs are those psychotherapeutic drugs used to modify emotions and behavior in the treatment of psychiatric illnesses. This statement will limit its scope to drug selection guidelines for those psychoactive agents used during pregnancy for prevention or treatment of the following common psychiatric disorders: schizophrenia, major depression, bipolar disorder, panic disorder, and obsessive-compulsive disorder. The statement assumes that pharmacologic therapy is needed to manage the psychiatric disorder. This decision requires thoughtful psychiatric and obstetric advice.

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“…A single case of the sacrococcygeal teratoma associated with tranylcypromine and trifluoperazine use has been reported (Bergamaschi and Berlingier, 1968). Pavy et al (1995) reported a case of a 25-year-old woman who took 45 mg per day of phenelzine throughout pregnancy and labor, and delivered a healthy male child by Caesarean section at 37 weeks of gestation. Ramin et al (1992) have reviewed several animal MAOI teratology studies.…”

Section: Introductionmentioning

confidence: 98%

Phenelzine use throughout pregnancy and the puerperium: Case report, review of the literature, and management recommendations

Gracious

Wisner

1997

Depress. Anxiety

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Anaesthetic management of labour and delivery in a woman taking long-term MAOI

Cited by 20 publications

References 10 publications

Antidepressant treatment with MAO-inhibitors during general and regional anesthesia: A review and case report of spinal anesthesia for lower extremity surgery without discontinuation of tranylcypromine

Antidepressant treatment with MAO-inhibitors during general and regional anesthesia: A review and case report of spinal anesthesia for lower extremity surgery without discontinuation of tranylcypromine

Use of Psychoactive Medication During Pregnancy and Possible Effects on the Fetus and Newborn

Phenelzine use throughout pregnancy and the puerperium: Case report, review of the literature, and management recommendations

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