The following drugs, previously or currently being taken may influence present anaesthesia.
Prolonged steroid therapy (> 10mg prednisolone/day) results in atrophy of the adrenal glands so that they cannot secrete extra hormones in time of stress. Collapse, with a fall of blood pressure, may ensue. Many differentregimes have been described to provide perioperative steroid cover. The principles are as follows:
Hydrocortisone sodium succinate (rapidly acting) is the drug mostfrequently used.
Steroid cover is provided if the patient has had steroids in the threemonths before surgery unless the surgery is very minor and imposesvery little stress on the patient.
Hydrocortisone is administered at induction.Dose: 25mg IV (adult)
Any unexplained fall in blood pressure either during or after surgery istreated with steroids. However hypotension from more common causesi.e. blood loss or hypoxia must be excluded.
The steroid cover is maintained until the stress of the operative and post-operative period is over and then gradually reduced.
For a more detailed description of this regime see Chapter 40 Antihypertensive drugs
These drugs produce their effect by a reduction in peripheral vascular tone.This tends to interfere with circulatory homeostasis under anaesthesia. Most patients are left on these tablets until the day of operation. The anaesthetistmust bear in mind that these patients cannot compensate for such stresses as blood loss, changes in posture, intermittent positive pressure ventilation(IPPV), etc. in the same way as normal patients can. Further, they may react badly to drugs such as thiopentone which can cause a fall in blood pressure.
Monoamine oxidase inhibitors (MAOI)
The actions of these drugs are imperfectly understood. They interact withnarcotic analgesics, e.g. pethidine and morphine and result in various bizarrereactions - severe hypo or hypertension, coma, convulsions, Cheyne Stokesrespiration and death. They also react abnormally with pressor drugs and potentiate the side effects of barbiturates. The effects of MAOI last from 1 to2 weeks depending on the drugs. Suspension of MAOI will be necessary for major surgery requiring post-operative analgesia. This must be done 10 to14 days pre-operatively.