주술기 정신작용약물 사용시 고려해야 할 사항 = Considerations for Use of Psychotropic Drugs in the Perioperative Period

국문 초록 (Abstract)

정신질환을 앓고 있는 환자들이 신체질환으로 수술적 치료를 받는 경우가 점점 늘어나고 있다. 정신작용약물을 복용 중인 환자들은 약물간 상호작용, 금단증상, 정신질환의 재발이나 악화 등으로 수술 전후 합병증이 증가할 수 있다. 그러므로 주술기 정신작용약물 사용에 대한 관리는 수술 후 결과를 개선하는데 매우 중요하다.
본 논문은 주요 정신작용약물의 주술기 사용시 고려해야 할 사항과 권고안에 대하여 기술하였다. 미국 마취과학회 신체분류 등급과 같은 신체적 건강 관련 요인이 주술기 정신작용약물 사용 여부를 판단하는데 중요한 요소로 고려된다. 신체적으로 건강하거나 경한 신체질환이 있는 환자의 경우, 대부분의 정신작용약물은 정신질환의 재발을 방지하기 위해 주술기 동안 계속 사용하는 것이 권고된다. 그러나 클로자핀과 리튬은 심각한 약물간상호작용과 잠재적 독성 때문에 수술 전 투여를 중단해야 한다. 신체적 또는 정신적으로 심각한 질환으로 기능장애가 있는 환자의 경우, 주술기 동안 정신작용약물을 유지할 때 위험성과 중단했을 때 정신질환 재발 위험성사이의 균형을 맞추어 약물 사용 여부를 개별화해야 한다. 최신 연구와 전문가 의견을 기반으로 한 주술기 정신작용약물 사용 가이드라인의 개발은 주술기 환자 치료의 질을 향상시키는데 기여할 수 있을 것이다.

다국어 초록 (Multilingual Abstract)

Recently, a number of patients with psychiatric disorders have received surgical treatments due to physical diseases. Patients who use psychotropic drugs and require surgery have increased perioperative complica tions because of drug-drug interactions, risk of withdrawal symptoms, and recurrence or relapse of psychiatric disorders. Hence, perioperative management of psychotropic medications is crucial for improving the postopera tive outcomes. This paper attempts to provide an overview of considerations and recommendations for periopera tive use of major psychotropic drugs. Physical health-related factors such as the American Society of Anesthesi ologist Physical Status Classification System are considered key factors in the decision process for the use of psychotropic drugs in the perioperative period. For patients who are healthy or with mild physical disease, most psychotropic drugs are recommended to be maintained during the perioperative period to avoid relapse of psychi atric condition. However, clozapine and lithium need to be discontinued before surgery due to serious drug-drug interactions and potential toxicity. For patients who have severe physical or mental disease with functional im pairment, optimal use of psychotropic drugs should be individualized to balance the risk of maintaining psycho tropics in the perioperative period versus the risk of relapse of the underlying psychiatric condition if they are dis continued before surgery. Development of the guidelines for perioperative use and management of psychotropics based on recent research and expert opinions can contribute to improving the quality of patient care in the periop erative setting.

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