Monoamine oxidase inhibitors: should they be discontinued preoperatively?

Adverse cardiovascular responses to anesthesia during either electroconvulsive therapy (ECT) or elective surgical procedures were evaluated in 27 patients maintained on chronic (3 months-3 yr) monoamine oxidase inhibitor (MAOI) therapy. Changes in blood pressure and heart rate in study patients (n = 22 ECTs in 13 patients) undergoing ECT were not significantly different from those observed in patients having ECT without prior treatment with MAOIs (n = 45 ECTs in 45 patients). In both groups, blood pressure and heart rate increased significantly after ECT, but returned to baseline levels within 15 min. No complications attributable to MAOIs were observed in study patients (n = 14) undergoing elective surgical procedures. We conclude that discontinuing chronic MAOI therapy prior to anesthesia and surgery is not necessary.