Preoperative Evaluation of Patients With Neurological Disease

Kathrin Lieb, MD; Magdy H. Selim, MD, PhD

Semin Neurol. 2008;28(5):603-610.

Conclusions

The preoperative time is critical for any neurological patient undergoing surgery. Neurological patients are at an increased risk for perioperative cardiac and pulmonary complications after surgery. The secondary complications of neurological diseases such as aspiration pneumonia, respiratory difficulties, electrolyte abnormalities, autonomic dysfunction, and muscle weakness can adversely influence postsurgical outcome. A thorough preoperative assessment considering the complex pathophysiology of each individual patient is essential to improve perioperative care and to optimize patient's outcome.

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Reprint Address

Magdy H. Selim, MD, PhD, Department of Neurology, Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center, 330 Brookline Avenue - Palmer 127, Boston, MA 02215 E-Mail: mselim@bidmc.harvard.edu

Cite this: Preoperative Evaluation of Patients With Neurological Disease - Medscape - Nov 01, 2008.

Preoperative Management of Neurological and Psychiatric Medications
Neurological Medications
Antiparkinsonian Agents
Carbidopa/ levodopa	Continue until the morning of surgery and restart as soon as possible after surgery to avoid withdrawal syndrome
Selegiline	Stop 2 weeks prior to surgery when possible
Bromocriptine, amantadine, pergolide	Continue
Entacapone, tolcapone	Continue to avoid withdrawal syndrome; check liver enzymes before surgery
Antiepileptic Medications
Phenytoin, carbamazepine, valproic acid, clonazepam, phenobarbital, primidone, gabapentin, topiramate	Continue to avoid perioperative seizures
Antidepressants
Amitriptyline, nortriptyline, imipramine, desipramine	Continue but exercise caution with perioperative drug choices due to perioperative additive anticholinergic effects
MAO inhibitors Pargyline, phenelzine	Stop 14-21 days prior to surgery to avoid perioperative medication interactions; for emergency procedures, avoid sympathomimetics, anticholinergics, and meperidine
SSRIs:
Fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine Venlafaxine, mirtazapine, nefazodone	Continue to avoid withdrawal syndrome
Venlafaxine, mirtazapine, nefazodone	No association with withdrawal syndrome known; no known interactions with anesthetic agents^[14]
Antipsychotics, Mood Stabilizers, Anxiolytics
Phenothiazines	To avoid withdrawal dyskinesia or rebound agitation continue perioperatively if possible^[15]
Butyrophenones
Lithium	Continue pre- and perioperatively; check serum levels prior to surgery;^[10] obtain thyroid function tests if indicated; monitor serum sodium, avoid sodium wasting diuretics^[12]
Benzodiazepines	Continue to avoid withdrawal seizures

MAO = monoamine oxidase; SSRIs = selective serotonin reuptake inhibitors.
Adapted from Mercado DL, Petty BG.^[10]

Preoperative Management of Neurological and Psychiatric Medications
Neurological Medications
Antiparkinsonian Agents
Carbidopa/ levodopa	Continue until the morning of surgery and restart as soon as possible after surgery to avoid withdrawal syndrome
Selegiline	Stop 2 weeks prior to surgery when possible
Bromocriptine, amantadine, pergolide	Continue
Entacapone, tolcapone	Continue to avoid withdrawal syndrome; check liver enzymes before surgery
Antiepileptic Medications
Phenytoin, carbamazepine, valproic acid, clonazepam, phenobarbital, primidone, gabapentin, topiramate	Continue to avoid perioperative seizures
Antidepressants
Amitriptyline, nortriptyline, imipramine, desipramine	Continue but exercise caution with perioperative drug choices due to perioperative additive anticholinergic effects
MAO inhibitors Pargyline, phenelzine	Stop 14-21 days prior to surgery to avoid perioperative medication interactions; for emergency procedures, avoid sympathomimetics, anticholinergics, and meperidine
SSRIs:
Fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine Venlafaxine, mirtazapine, nefazodone	Continue to avoid withdrawal syndrome
Venlafaxine, mirtazapine, nefazodone	No association with withdrawal syndrome known; no known interactions with anesthetic agents^[14]
Antipsychotics, Mood Stabilizers, Anxiolytics
Phenothiazines	To avoid withdrawal dyskinesia or rebound agitation continue perioperatively if possible^[15]
Butyrophenones
Lithium	Continue pre- and perioperatively; check serum levels prior to surgery;^[10] obtain thyroid function tests if indicated; monitor serum sodium, avoid sodium wasting diuretics^[12]
Benzodiazepines	Continue to avoid withdrawal seizures

MAO = monoamine oxidase; SSRIs = selective serotonin reuptake inhibitors.
Adapted from Mercado DL, Petty BG.^[10]

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