QUEEN146S UNIVERSITYDEPARTMENT OF ANESTHESIOLOGY Subject Perioperative Management of Monoamine Oxidase Inhibitors MAOI NUMBER PAGE ORIGINAL ISSUE REVIEWED REVISIO ID: 942451
Download Pdf The PPT/PDF document "KINGSTON GENERAL HOSPITAL" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
KINGSTON GENERAL HOSPITAL QUEEN’S UNIVERSITYDEPARTMENT OF ANESTHESIOLOGY Subject: Perioperative Management of Monoamine Oxidase Inhibitors (MAOI) NUMBER PAGE ORIGINAL ISSUE REVIEWED REVISION Trade Name Generic NameParnateTranylcypromineNardilPhenelzineManerixMoclobemide Introduction:The classic MAOI, phenelzine and tranylcypromine, irreversibly inhibit MAO for 2 to 3 weeks until new enzyme is synthesized.1 Moclobemide, a reversible inhibitor of MAO-A (RIMA) causes enzyme inhibition for less than 24 hours.2,3 Due to potential drug interactions, discontinuation of classic MAOI 2 to 3 weeks before surgery has been recommended1 and suitability of these patients for ambulatory anesthesia has been controversial. Reactions to meperidine (including agitation, hyper/hypotension, convulsions, hyperthermia, and coma.3) have been described for all MAOI1,4,5 and RIMA2,3 medications. Cocaine also may cause excitatory reactions 6 Patients may have an e
xaggerated response to indirect-acting sympathomimetics as long as 3 weeks after classic MAOI are discontinued.1 Regarding RIMA’s, a patient taking moclobemide had a normal response to both phenylephrine and ephedrine after omitting the morning dose2. Vasopressors at concentrations contained in local anesthetics are not likely to be significantly potentiated in otherwise healthy patients on an MAOI.11 7-15. Withdrawal of MAOI 2 weeks prior to elective surgery is not without risks and acute exacerbation of depression with suicidal idereported.17 Although adverse drug interactions are possible and have been reported in a minority of patients on MAOI, a wide range of anesth file:///I|/Dept%20Anesthesia%20Website/POLICIES/MAOI%20policy.htm (1 of 3)26/12/2007 2:06:32 PM KINGSTON GENERAL HOSPITAL has been described that permit the safe administration of anesthesia. Therefore, patients taking either classic or selective MAOfor ambulatory anesthesia without discontinuing their MAO
I preoperatively if careful attention is paid to their anesthetic manag Policy: 1. Patients taking MAOIs may continue taking their medication throughout the perioperative period. 2. Meperidine, cocaine and indirect-acting catecholamines should be avoided in these patients. References: 1. Wells DG, Bjorksten AR. Monoamine oxidase inhibitors revisited. Can J Anaesth 1989; 36: 64-74. oxidase inhibitor. Anaesthesia 1996; 51: 1150-2. 4. Stack CG, Rogers P, Linter SPK. Monoamine oxidase inhibitors and anaesthesia. A review. Br J Anaesth 1988; 60: 222-7. (phenelzine). Br J Anaesth 1991; 66: 516-8. Anesth Analg 1985; 64: 592-8. O’Hara JF, Maurer WG, Smith MP. Sufentanil-isoflurane-nitrous oxide anesthesia for a patient treated with monoamine oxidase itricyclic antidepressant. J Clin Anesth 1995; 7: 148 –50. Anaesth 1998; 45: 706-9. 311-5. Anesth 1996; 8: 245-7. file:///I|/Dept%20Anesthesia%20Website/POLICIES/MAOI%20policy.htm (2 of 3)26/12/2007 2:06:32 P