Comprehensive Perioperative Management Considerations in Patients Taking Methadone.

PURPOSE OF REVIEW: Well-informed staff can help decrease risks and common misconceptions regarding opioid-tolerant patients, especially those taking methadone. RECENT FINDINGS: In 2015, opioid pain relievers were the second most used drug at 3.8 million. Overdose death was three times greater in 2015 than in 2000. Medication-assisted treatment was sought by more than 2 million individuals with substance use disorder, one of which is methadone. Chronic pain affects millions of adults in the USA. Opioid therapy is widely used among these adults. Related to the risk of abuse and dependence, guidelines suggest that opioid therapy may not be considered first-line treatment. A multidisciplinary approach, including thorough preoperative evaluation, the utilization of multimodal pain management strategies, and opioid-sparing techniques in both the intraoperative and postoperative periods will allow for the best possible outcome.

Perioperative implications of common and newer psychotropic medications used in clinical practice.

Psychotropic medications are widely prescribed by clinicians as both primary therapy for a variety of psychiatric and neurodegenerative diseases and as adjunctive analgesics for use in the perioperative period. It is critical to understand various modes of action, drug-drug interactions, side effects, and clinical implications. Health care providers must understand how these medications interact with anesthetics, as well as other drugs used in perioperative care. We review relevant psychiatric and neurodegenerative diseases, psychotropic medications used to treat them, and how these medications interact with anesthetics and drugs used in perioperative care. We will also discuss emerging psychotropic drugs and the challenges they may create during the perioperative period. Future direction of investigation into the role of these drugs during the perioperative period and implications is also discussed.

Postinduction Paced Pulseless Electrical Activity in a Patient With a History of Oropharyngeal Instrumentation-Induced Reflex Circulatory Collapse.

BACKGROUND: Reflex hypotension and bradycardia have been reported to occur following administration of several drugs associated with administration of anesthesia and also following a variety of procedural stimuli. CASE REPORT: A 54-year-old postmenopausal female with a history of asystole associated with sedated upper gastrointestinal endoscopy and post-anesthetic-induction tracheal intubation received advanced cardiac resuscitation after insertion of a temporary transvenous pacemaker failed to prevent pulseless electrical activity. The patient's condition stabilized, and she underwent successful cataract extraction, intraocular lens implantation, and pars plana vitrectomy. CONCLUSION: Cardiac pacemaker insertion prior to performance of a procedure historically associated with reflex circulatory collapse can be expected to protect a patient from bradycardia but not necessarily hypotension.