Catalani Blas, Hamilton Craig S, Herron Edwin W, Urman Richard D, Fox Charles J, Kaye Alan David
Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Best Pract Res Clin Anaesthesiol. 2014 Jun;28(2):167-81. doi: 10.1016/j.bpa.2014.05.001. Epub 2014 May 22.
The use of antidepressants, anxiolytics, mood stabilizers, anticonvulsants, and major tranquilizers introduces neurochemical, behavioral, cognitive, and emotional factors that increase the complexity of medical and surgical tasks. Increasingly, various classes of psychotropic medications are being prescribed in the perioperative setting for their analgesic properties in patients with or without a psychiatric diagnosis. In many cases, the precise mechanisms of action and dose-response relationships by which these agents mediate analgesia are largely unclear. An appreciation of the side effects and adverse-effect profiles of such medications and familiarity with the clinically relevant drug interactions that may occur in the perioperative setting are imperative to ensure the best possible outcome in dealing with patients on these medications. This review focuses on various classes of psychotropic agents, which are addressed individually, with particular focus on their analgesic properties. The latest published research is summarized, deficiencies in our current collective knowledge are discussed, and evidence-based recommendations are made for clinical practice.
抗抑郁药、抗焦虑药、心境稳定剂、抗惊厥药和强效镇静剂的使用引入了神经化学、行为、认知和情感因素，这些因素增加了医疗和外科手术任务的复杂性。越来越多的各类精神药物在围手术期被开具处方，用于有或没有精神疾病诊断的患者，以发挥其镇痛特性。在许多情况下，这些药物介导镇痛的精确作用机制和剂量反应关系在很大程度上尚不清楚。了解此类药物的副作用和不良反应情况，并熟悉围手术期可能发生的临床相关药物相互作用，对于确保处理服用这些药物的患者时获得最佳结果至关重要。本综述重点关注各类精神药物，对其进行单独探讨，特别关注它们的镇痛特性。总结了最新发表的研究，讨论了我们目前总体知识中的不足，并为临床实践提出了基于证据的建议。
