Severe interactions with classic and selective monoamine oxidase inhibitors

Abstract

Oculocardiac reflex-peHbulbar block or opioid-relaxant anaesthesiaTo the Editor: The Oculocardiac reflex (OCR) can be induced by traction on the extraocular muscles. It usually manifests as bradycardia, nodal rhythm, ectopic beats, ventricular fibrillation and asystole. The reported incidence of OCR during general anaesthesia (GA) varies from 56 -67%. 1,5 This study was designed to compare the effects of peribulbar block (LA) and opioid-relaxant anaesthesia on the incidence of OCR in 30 patients undergoing surgery for retinal detachment. Traction of 400 g was applied to all extraocular muscles using a sprhag balance.Patients in group I underwent surgery using peribulbar block. In group II patients received conventional opioid-relaxant anaesthesia. Intraoperative monitoring included SpO2, PETCO2, heart rate, and arterial pressure every 5 rain. The ECG, lead II, was recorded prior to anaesthesia, and during and after traction of each extraocular muscle. OCR was considered positive if there was 10% decrease in heart rate. Analysis was with chi-square and student's t test.There was a decrease in heart rate following traction on the rectus muscles (P < 0.0005) and oblique muscles (P < 0.005) during GA (Table ). The maximum change in heart rate was observed for inferior rectus. There was no decrease in heart rate, using local anaesthesia, for muscle. There were no alterations in arterial pressure under LA or GA. The incidence of dysrhythmias was 20% under GA and 6.67% under LA. These results demonstrate that the incidence of OCR during GA (63.3%) is higher than during LA (14.4%).

Electroconvulsive Therapy in Patients Taking Monoamine Oxidase Inhibitors

“…Anticholinergic agents used include glycopyrrolate and atropine, neither of which should adversely interact with MAOIs, although there are 2 reports of severe hypertensive reactions and arrhythmias in patients tak- ing MAOIs (one taking phenelzine and one taking selegiline) who both received ephedrine and atropine. 16 Presumably, the patients' adverse reactions were from the combination of the MAOI and the ephedrine, but the fact that both patients received atropine confounds the issue. In a review of MAOI and elective surgery, 47 patients received atropine as a premedication without any untoward effect.…”

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

“…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]. In contrast, moclobemide and ephedrine did not yield an interaction in one patient [30].…”

Harmless herbs: a cause for concern?

“…For example, a 21‐year‐old on an MAOI, developed hypotension and bradycardia while under spinal anaesthesia. This was treated with ephedrine and atropine but she subsequently developed agitation, dyspnoea, severe headache, hypertension and tachycardia [2]. Churchill‐Davidson advised checking patients' sensitivity to MAOIs and opioids by giving a test dose of 5 mg of pethidine and monitoring vital signs regularly [3].…”