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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Lisamac on May 13, 2001, at 5:59:07
I have been on Parnate off and on for years. I always go back to it, as it seems to be the only AD that truely helps. Last year I had a hysterectomy and my GYN. freaked and made me stay off of it for 2 weeks prior to surgery.
I am having a 3 level fusion Tuesday, with plates and screws. My surgeon DID not tell me to stop taking it this time. He acted like it was no big deal. I told him absolutely no demerol and he wrote that on my chart, along with check for all adverse medication. He said as long as the anesthesiologist knew i was taking it, it would be fine. Now I am getting scared. I haven't had one since the 9th of May. Does anyone know if morphine is ok? I know i will be using the "pump" in the hospital. You guys here are so knowledgeable here, and i appreciate your feedback. What will they use???
Thank you in advance,
Lisa
Posted by Seamus2 on May 13, 2001, at 10:12:25
In reply to Parnate and Sugery...Please respond, posted by Lisamac on May 13, 2001, at 5:59:07
Morphine is okay (I had some w/ Parnate)
But I would be careful w/ beta agonists. They may needed if your BP falls dramatically. Parnate can exaggerate the effect of these drugs.
Posted by Ann NY on May 13, 2001, at 10:14:51
In reply to Parnate and Sugery...Please respond, posted by Lisamac on May 13, 2001, at 5:59:07
Lisa:
I'm sorry to hear of your health problems. That's a huge thing to deal with.
A first step may be to go the the manufacture's web site. Perscription drug companies are now required to keep the FDA required labeling info. on it -- and are held to higher standards than the PDR regarding updates.
I wouldn't trust anyone's opinion but an anesthesiologist's. Can you get your GP to call one for a quick consult? Surgeon's don't keep up on meds.
I'm sure others here will be more helpful. I hope all goes well for you!
> I have been on Parnate off and on for years. I always go back to it, as it seems to be the only AD that truely helps. Last year I had a hysterectomy and my GYN. freaked and made me stay off of it for 2 weeks prior to surgery.
> I am having a 3 level fusion Tuesday, with plates and screws. My surgeon DID not tell me to stop taking it this time. He acted like it was no big deal. I told him absolutely no demerol and he wrote that on my chart, along with check for all adverse medication. He said as long as the anesthesiologist knew i was taking it, it would be fine. Now I am getting scared. I haven't had one since the 9th of May. Does anyone know if morphine is ok? I know i will be using the "pump" in the hospital. You guys here are so knowledgeable here, and i appreciate your feedback. What will they use???
> Thank you in advance,
> Lisa
Posted by Michele on May 13, 2001, at 10:47:07
In reply to Re: Parnate and Sugery...Please respond, posted by Seamus2 on May 13, 2001, at 10:12:25
Lisa,
In my experience the anasthesiologist(sorry about the spelling... having insomnia and havent been to bed yet).... will call you before the surgery and get the scoop. He'll know what to do. But you may want to get aggressive... and ask for his name and give him a call.... it should put your mind at ease if nothing else. Best of luck to you.
Posted by Lisamac on May 14, 2001, at 9:46:03
In reply to Parnate and Sugery...Please respond, posted by Lisamac on May 13, 2001, at 5:59:07
> I have been on Parnate off and on for years. I always go back to it, as it seems to be the only AD that truely helps. Last year I had a hysterectomy and my GYN. freaked and made me stay off of it for 2 weeks prior to surgery.
> I am having a 3 level fusion Tuesday, with plates and screws. My surgeon DID not tell me to stop taking it this time. He acted like it was no big deal. I told him absolutely no demerol and he wrote that on my chart, along with check for all adverse medication. He said as long as the anesthesiologist knew i was taking it, it would be fine. Now I am getting scared. I haven't had one since the 9th of May. Does anyone know if morphine is ok? I know i will be using the "pump" in the hospital. You guys here are so knowledgeable here, and i appreciate your feedback. What will they use???
> Thank you in advance,
> Lisa
Thanks to all who responded! Hopefully i will get some more replies by tonight. Anyone out there had sugery while on an MOAI? Surgery is tomorrow!!(I was taking 10ml., have not had any since May 9th)
Hugs,
Lisa
Posted by SalArmy4me on May 14, 2001, at 14:04:47
In reply to Re: Parnate and Sugery...Please respond, posted by Lisamac on May 14, 2001, at 9:46:03
Here's what I found in my review of the literature:
Smith MS. Muir H. Hall R. Perioperative management of drug therapy, clinical considerations. [Review] [181 refs] Drugs. 51(2):238-59, 1996 Feb:
"...However, recent clinical experience has demonstrated the relative safety of continuing MAOIs prior to surgery by use of specific 'MAOI safe' anaesthetic techniques and/or substitution of short-acting MAOIs which do not irreversibly inhibit the enzyme."Abdi, Salahadin MD, PhD. Acute Exacerbation of Depression After Discontinuation of Monoamine Oxidase Inhibitor Prior to Cardiac Surgery. Anesthesia & Analgesia. 83(3):656-657, September 1996:
"This case report suggests that preoperative discontinuation of MAOIs can result in acute exacerbation of depression, which can involve intense suffering and can be life threatening through increased risk of impaired recovery as well as by posing the risk of suicide. Since the theoretical risks of discontinuing this class of drug prior to elective surgery are substantial and there are no convincing data to support or quantify the problems of such practice, we may need to rethink our approach in patients receiving preoperative MAOIs."el-Ganzouri AR. Ivankovich AD. Braverman B. McCarthy R. Monoamine oxidase inhibitors: should they be discontinued preoperatively? Anesthesia & Analgesia. 64(6):592-6, 1985 Jun:
"...We conclude that discontinuing chronic MAOI therapy prior to anesthesia and surgery is not necessary."
Posted by shelliR on May 14, 2001, at 17:57:37
In reply to Re: Parnate and Sugery...Please respond, posted by Lisamac on May 14, 2001, at 9:46:03
Lisa, I have had minor surgery while on an MAOI (nardil)--microscroptic knee surgery and also some diagnostic tests which required putting me under some sedation, or completely out.
I have always asked to meet with the anesthesiologist before surgery to talk about being on an MAOI. And it has always given me a wonderful sense of security. Anestesiologists seem to be a really nice group in my experience. One thing I have found out is that sedation wears off faster with an MAOI, so I am sure to remind the anes. to be aware of this and to err on the side of oversedating me (I don't want to wake up in the middle of surgery!).
Good luck; I'm sure all will go well. Shelli
Posted by Lisamac on May 14, 2001, at 20:07:12
In reply to Re: Parnate and Sugery...Please respond » Lisamac, posted by shelliR on May 14, 2001, at 17:57:37
Just wanted to thank each and eveyone one of you that took time the time to reply to my question!!!
I love this place, and you guys are the greatest. I feel so much better!!
Sal, especially thanks to you for going to all that trouble to find that article!!
and shelli, thanks for sharing you're experience.
I will sleep better tonight.Hugs,
Chanie
Posted by Elizabeth on May 15, 2001, at 10:43:23
In reply to Parnate and Sugery...Please respond, posted by Lisamac on May 13, 2001, at 5:59:07
Morphine + Parnate is fine. I have taken the combination myself, in fact. Morphine is the standard substitute for Demerol.
Same with general anaesthetics; they need to monitor your BP extra carefully to make sure you don't go into shock or something (!) and if pressor agents are needed they need to be careful (no indirect-acting pressors, in particular -- norepinephrine (Levophed) is the drug of choice in this situation), but any decently skilled anaesthesiologist ought to be able to deal with MAOIs.
Good luck with everything.
-elizabeth
Posted by Lawrence s. on May 17, 2001, at 1:05:00
In reply to Parnate and Sugery...Please respond, posted by Lisamac on May 13, 2001, at 5:59:07
> I have been on Parnate off and on for years. I always go back to it, as it seems to be the only AD that truely helps. Last year I had a hysterectomy and my GYN. freaked and made me stay off of it for 2 weeks prior to surgery.
> I am having a 3 level fusion Tuesday, with plates and screws. My surgeon DID not tell me to stop taking it this time. He acted like it was no big deal. I told him absolutely no demerol and he wrote that on my chart, along with check for all adverse medication. He said as long as the anesthesiologist knew i was taking it, it would be fine. Now I am getting scared. I haven't had one since the 9th of May. Does anyone know if morphine is ok? I know i will be using the "pump" in the hospital. You guys here are so knowledgeable here, and i appreciate your feedback. What will they use???
> Thank you in advance,
> Lisa
>Hi Lisa. I went into surgery while on Nardil. You have to watch the doctors and nurses because one nurse tried to give me a med. that was very bad to mix w/ maoi's and I actually had to argue with her saying that "I'm on an maoi, and that might kill me." when I told the Dr. later on, he too was sure the drug was OK. But I insited that he check his PDR. He later apologized for the near catastrophy saying your'e right. that is one of the worst drugs to mix w/ Maoi's.
Posted by Elizabeth on May 17, 2001, at 13:53:28
In reply to Re: Parnate and Sugery...Please respond, posted by Lawrence s. on May 17, 2001, at 1:05:00
> Hi Lisa. I went into surgery while on Nardil. You have to watch the doctors and nurses because one nurse tried to give me a med. that was very bad to mix w/ maoi's and I actually had to argue with her saying that "I'm on an maoi, and that might kill me."
That's often a problem in dealing with non-psychiatric medical professionals: they consider MAOIs obscure and hardly know anything about them. This has resulted in fatal mistakes before. (The best known such case involved a young woman named Libby Zion who was given Demerol while on (I think) Nardil. Her death resulted in massive reforms of the work schedules of medical students and residents, since it was believed to be due in part to her being treated by a sleep-deprived resident.)
Do you happen to remember what drug they wanted to give you?
It was pretty big of the doctor to admit he was wrong and apologise. Doctors generally *hate* being corrected, even if it's a life-or-death matter!
-elizabeth
Posted by Lawrence s. on May 20, 2001, at 8:50:44
In reply to Re: MAOIs and Sugery » Lawrence s., posted by Elizabeth on May 17, 2001, at 13:53:28
> > Hi Lisa. I went into surgery while on Nardil. You have to watch the doctors and nurses because one nurse tried to give me a med. that was very bad to mix w/ maoi's and I actually had to argue with her saying that "I'm on an maoi, and that might kill me."
>
> That's often a problem in dealing with non-psychiatric medical professionals: they consider MAOIs obscure and hardly know anything about them. This has resulted in fatal mistakes before. (The best known such case involved a young woman named Libby Zion who was given Demerol while on (I think) Nardil. Her death resulted in massive reforms of the work schedules of medical students and residents, since it was believed to be due in part to her being treated by a sleep-deprived resident.)
>
> Do you happen to remember what drug they wanted to give you?
> Sorry, but I can't remember.
> It was pretty big of the doctor to admit he was wrong and apologise. Doctors generally *hate* being corrected, even if it's a life-or-death matter!
>
> -elizabeth
This is the end of the thread.
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