Attention‐deficit hyperactivity disorder and anesthesia

Forsyth, Ian; Bergesio, R.; Chambers, Neil

doi:10.1111/j.1460-9592.2005.01830.x

Cited by 14 publications

(8 citation statements)

References 19 publications

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“…However, since loss of consciousness occurs at approximately 1/3 of MAC for sevoflurane [ 43 ] it is possible that the dose of sevoflurane was too high to detect a difference between the two groups. Since ADHD is estimated to have a worldwide prevalence of 6 to 12% [ 44 ] and many children are now taking stimulant medications regularly, more studies are needed to establish how these medications affect anesthesia care.…”

Section: Discussionmentioning

confidence: 99%

Dextroamphetamine (but Not Atomoxetine) Induces Reanimation from General Anesthesia: Implications for the Roles of Dopamine and Norepinephrine in Active Emergence

et al. 2015

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Methylphenidate induces reanimation (active emergence) from general anesthesia in rodents, and recent evidence suggests that dopaminergic neurotransmission is important in producing this effect. Dextroamphetamine causes the direct release of dopamine and norepinephrine, whereas atomoxetine is a selective reuptake inhibitor for norepinephrine. Like methylphenidate, both drugs are prescribed to treat Attention Deficit Hyperactivity Disorder. In this study, we tested the efficacy of dextroamphetamine and atomoxetine for inducing reanimation from general anesthesia in rats. Emergence from general anesthesia was defined by return of righting. During continuous sevoflurane anesthesia, dextroamphetamine dose-dependently induced behavioral arousal and restored righting, but atomoxetine did not (n = 6 each). When the D1 dopamine receptor antagonist SCH-23390 was administered prior to dextroamphetamine under the same conditions, righting was not restored (n = 6). After a single dose of propofol (8 mg/kg IV), the mean emergence times for rats that received normal saline (vehicle) and dextroamphetamine (1 mg/kg IV) were 641 sec and 404 sec, respectively (n = 8 each). The difference was statistically significant. Although atomoxetine reduced mean emergence time to 566 sec (n = 8), this decrease was not statistically significant. Spectral analysis of electroencephalogram recordings revealed that dextroamphetamine and atomoxetine both induced a shift in peak power from δ (0.1–4 Hz) to θ (4–8 Hz) during continuous sevoflurane general anesthesia, which was not observed when animals were pre-treated with SCH-23390. In summary, dextroamphetamine induces reanimation from general anesthesia in rodents, but atomoxetine does not induce an arousal response under the same experimental conditions. This supports the hypothesis that dopaminergic stimulation during general anesthesia produces a robust behavioral arousal response. In contrast, selective noradrenergic stimulation causes significant neurophysiological changes, but does not promote behavioral arousal during general anesthesia. We hypothesize that dextroamphetamine is more likely than atomoxetine to be clinically useful for restoring consciousness in anesthetized patients, mainly due to its stimulation of dopaminergic neurotransmission.

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Section: Discussionmentioning

confidence: 99%

Dextroamphetamine (but Not Atomoxetine) Induces Reanimation from General Anesthesia: Implications for the Roles of Dopamine and Norepinephrine in Active Emergence

et al. 2015

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“…Several potential interactions between anesthetic and ADHD drugs have been postulated; however, there are very little data to suggest that these are clinically important (4). One potential consequence of anesthetic–ADHD drug interactions may be inadequate sedation.…”

Section: Discussionmentioning

confidence: 99%

“…Potential issues related to anesthetizing children with these disorders include increased anxiety preoperatively, agitation during the induction of and emergence from anesthesia, postoperative behavioral changes, and interaction between anesthetic and ADHD drugs, e.g., methylphenidate (4). However, despite the clinical and societal importance of these potential interactions, there are no studies, to our knowledge, that have comprehensively examined the effects of anesthesia on children with these disorders.…”

Section: Introductionmentioning

confidence: 99%

Anesthesia induction, emergence, and postoperative behaviors in children with attention‐deficit/hyperactivity disorders

Tait

Voepel‐Lewis

Burke

et al. 2010

Pediatric Anesthesia

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This is the first prospective study to our knowledge that has examined the perioperative and postoperative behaviors of children with ADHD compared to those without this disorder. These results are important in alerting anesthesiologists, parents, and teachers to the potential for difficulties during induction of anesthesia and postoperative behavioral problems at home and in school, respectively.

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“…Stimulant medications have the potential to interact with anesthetic drugs in a variety of ways (3). Stimulants increase levels of norepinephrine and dopamine, and both these neurotransmitters exert wake‐promoting actions within a network of subcortical regions and certain stimulants are used in the treatment for narcolepsy.…”

Section: Introductionmentioning

confidence: 99%

“…The wake‐promoting effects of norepinephrine involve synergistic actions of α1 and β receptors, whereas dopamine‐induced waking involves both D1 and D2 receptors (4). Stimulants may therefore have the potential to increase perioperative alertness or arousal and increase anesthetic agent MAC (3,5–7), but there is limited, if any, evidence for any such clinical effect during anesthesia in children.…”

Section: Introductionmentioning

confidence: 99%

Ingestion of stimulant medications does not alter bispectral index or clinical depth of anesthesia at 1 MAC sevoflurane in children

Chambers

Pascoe

Kaplanian

et al. 2011

Pediatric Anesthesia

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Children taking stimulant medication for ADHD, and who ingest medication on the day of surgery, do not appear to have altered BIS or depth of anesthesia at 1 MAC of sevoflurane. These results do not support a recommendation for a change in anesthetic practice for children having ingested stimulants up to the day of surgery, either in terms of increasing the amount of anesthetic given or monitoring of depth.

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Attention‐deficit hyperactivity disorder and anesthesia

Cited by 14 publications

References 19 publications

Dextroamphetamine (but Not Atomoxetine) Induces Reanimation from General Anesthesia: Implications for the Roles of Dopamine and Norepinephrine in Active Emergence

Dextroamphetamine (but Not Atomoxetine) Induces Reanimation from General Anesthesia: Implications for the Roles of Dopamine and Norepinephrine in Active Emergence

Anesthesia induction, emergence, and postoperative behaviors in children with attention‐deficit/hyperactivity disorders

Ingestion of stimulant medications does not alter bispectral index or clinical depth of anesthesia at 1 MAC sevoflurane in children

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