Anaesthetic implications of psychoactive drugs

The management of patients on psychoactive medications in the perioperative period is largely based on the individual clinician’s experience. Despite 10% of the UK population having some form of mental health condition, there is surprisingly little by way of guidelines for the perioperative management of patients who may be on medications with significant anaesthetic implications. Challenges for the anaesthetist may arise from the nature of the psychiatric condition itself, interactions of psychoactive and anaesthetic drugs, and the problems caused by the condition requiring surgery (e.g. electrolyte derangement and prolonged periods of fasting). Patients may also present for electroconvulsive therapy (ECT) under general anaesthesia. This article aims to summarize the commonly used groups of psychoactive medications and outline their implications for the anaesthetist, which are summarized in Table 1. We have chosen not to discuss the benzodiazepines as all anaesthetists should already have a good working knowledge of this group of drugs. ECT will not be considered further as this is covered in an accompanying article.