Medication Considerations in the Context of Surgery and Anesthesia

There are no current studies on outcomes to guide psychotropic medication treatment around pediatric surgical procedures. Huyse et al. (2006) proposed guidelines for the management of psychotropic medications around elective surgery. In doing so, they noted that there were limited systemic studies available to guide this area of clinical practice. They recommended consideration of the extent of the surgery, the patient's physical state, potential drug interactions, effects and side effects of psychotropic medications, risk of withdrawal symptoms, and risk of psychiatric recurrence or relapse when medication treatment is interrupted. Crone and Gabriel (2004) discussed the need to carefully assess changing pharmacokinetic parameters in patients undergoing organ transplantation. In the immediate preoperative period, medications may need to be administered at alternate times or via alternate routes when patients cannot take medications, food, or fluids by mouth. If medications are to be held, care should be taken to avoid discontinuation signs and symptoms.

Przybylo et al. (2003) reported in a pilot study that transient behavioral abnormalities occurred at significant rates in children undergoing general anesthesia and surgery. Behavioral changes did not prolong recovery in these cases, suggesting that postanesthesia behavioral changes usually resolve spontaneously without need for psychopharmaco-logical interventions and were predominantly due to the short-term effects of the anesthetic agents. Kain et al. (2006) reported that higher levels of pre-operative anxiety were associated with a higher incidence of emergence delirium, more postoperative analgesic use, and more complaints of pain. There have been case reports of bleeding possibly associated with SSRIs and second-generation antipsychotics (Coskun and Mukaddes 2008; Holzer and Halfon 2006; Lake et al. 2000).

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