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

Chambers, Neil; Pascoe, Elaine M.; Kaplanian, Serge; Forsyth, Ian

doi:10.1111/j.1460-9592.2011.03717.x

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…However, there are also reports suggesting that patients taking stimulants prior to surgery do not have increased anesthetic requirements, and therefore may be safely anesthetized without discontinuing the medications preoperatively [ 41 ]. Chambers et al [ 42 ] found that BIS values during 1 MAC sevoflurane anesthesia were not significantly different in children taking stimulant medications vs. controls. 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.…”

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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“…The present study included a control group composed of children with ADHD who did not take stimulant medication prior to surgery, allowing comparison between individuals with similar underlying central nervous system dysfunction. Furthermore, the inclusion of 48 children with ADHD in this analysis improved upon prior evaluations of perioperative hypotension in patients with ADHD, which included a case series of 8 adults , and an observational study enrolling 17 children with ADHD . Notwithstanding the larger sample of patients with ADHD in our study, we did not detect any intraoperative hypotension in the study cohort.…”

Section: Discussionmentioning

confidence: 93%

“…With these limited data to support the practice, it has been suggested that stimulant medications should not be administered on the day of surgery to avoid the possibility of refractory hypotension and/or bradycardia in the perioperative period. However, not all of the relevant literature supports this practice . Fischer et al .…”

Section: Introductionmentioning

confidence: 99%

“…Chambers et al . reported no significant difference in bispectral index (BIS), systolic blood pressure (SBP), diastolic blood pressure (DBP), or heart rate (HR) after 10 min at 1 minimum alveolar concentration (MAC) of sevoflurane in ADHD patients who received stimulant medication through the morning of surgery compared to controls without a history of ADHD .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hemodynamic profile and behavioral characteristics during induction of anesthesia in pediatric patients with attention deficit hyperactivity disorder

Cartabuke

Tobias

Rice

et al. 2017

Pediatric Anesthesia

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The evidence suggests that continuing preoperative stimulant medication is not associated with cardiovascular instability in the pediatric population. The evidence suggests that withholding or allowing stimulant medication preoperatively does not improve behavior on anesthetic induction or reduce the need for anxiolytic medication. Research efforts should focus on perioperative management strategies that will decrease the likelihood of long-term behavioral issues.

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“…Conversely, a study of 34 children taking methylphenidate and dexamphetamine for ADHD found no alteration of bispectral index or clinical depth of anesthesia at 1 MAC sevoflurane between patients continuing versus stopping the stimulant medication treatment on the day of surgery. 11 In addition, case reports published in 2000 and 2006 demonstrated anesthesia without complication or alteration of MAC requirements in multiple patients on chronic amphetamine treatment who took the drug on the morning of surgery. 12 , 13 The authors of these case reports recommended close cardiovascular monitoring and the use of direct-acting vasopressors such as epinephrine or phenylephrine for hypotension.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Outcome of Dyssomnia Patients on Chronic Methylphenidate Use

Stoicea

Ellis

Moran

et al. 2014

Journal of Investigative Medicine High Impact Case Reports

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Methylphenidate is frequently prescribed for attention deficit hyperactivity disorder, narcolepsy, and other sleep disorders requiring psychostimulants. Our report is based on 2 different clinical experiences of patients with chronic methylphenidate use, undergoing general anesthesia. These cases contrast different strategies of taking versus withholding the drug treatment on the day of surgery. From the standpoint of anesthetic management and patient safety, the concerns for perioperative methylphenidate use are mainly related to cardiovascular stability and possible counteraction of sedatives and anesthetics.

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

Cited by 11 publications

References 11 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

Hemodynamic profile and behavioral characteristics during induction of anesthesia in pediatric patients with attention deficit hyperactivity disorder

Perioperative Outcome of Dyssomnia Patients on Chronic Methylphenidate Use

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