Perioperative Management of Tricyclic Antidepressants

Rationale for Continuation

• The American Society of Anesthesiologists and other medical guidelines suggest that tricyclic antidepressants like nortriptyline should be continued perioperatively, as there is no specific contraindication for their use during surgery, and withdrawal risks outweigh surgical concerns 1, 2, 3, 4

Important Perioperative Considerations

Specific Anesthetic Precautions

• Patients on tricyclic antidepressants may have enhanced responses to anesthetic agents due to norepinephrine potentiation, requiring careful titration and monitoring 2

Common Pitfalls to Avoid

• The Mayo Clinic recommends monitoring for serotonin syndrome when patients are taking nortriptyline and other serotonergic agents perioperatively, such as certain opioids 3