Quetiapine (QTP) is a short-acting atypical antipsychotic drug that treats schizophrenia or manic episodes of bipolar disorder. Human serum albumin (HSA) is an essential transport protein that transports hormones and various other ligands to their intended site of action. The interactions of QTP with HSA and their binding mechanism in the HSA-QTP system was studied using spectroscopic and molecular docking techniques. The UV-Vis absorption study shows hyperchromicity in the spectra of HSA on the addition of QTP, suggesting the complex formation and interactions between QTP and HSA. The results of intrinsic fluorescence indicate that QTP quenched the fluorescence of HSA and confirmed the complex formation between HSA and QTP, and this quenching mechanism was a static one. Thermodynamic analysis of the HSA-QTP system confirms the involvement of hydrophobic forces, and this complex formation is spontaneous. The competitive displacement and molecular docking experiments demonstrated that QTP is preferentially bound to HSA subdomain IB. Furthermore, the CD experiment results showed conformational changes in the HSA-QTP system. Besides this, the addition of QTP does not affect the esterase-like activity of HSA. This study will help further understand the credible mechanism of transport and delivery of QTP via HSA and design new QTP-based derivatives with greater efficacy.

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A Comprehensive Investigation of Interactions between Antipsychotic Drug Quetiapine and Human Serum Albumin Using Multi-Spectroscopic, Biochemical, and Molecular Modeling Approaches

Abstract Background Methamphetamine abuse is a serious public health concern and causes various life-threatening disorders including pulmonary arterial hypertension (PAH). Herein, we present the first case report describing the anesthetic management of a patient with methamphetamine-associated PAH (M-A PAH) undergoing laparoscopic cholecystectomy. Case presentation A 34-year-old female with M-A PAH suffered from deterioration of right ventricular (RV) heart failure due to recurrent cholecystitis and was scheduled for laparoscopic cholecystectomy. Preoperative assessment of PA pressure showed 82/32 (mean, 50) mmHg, and transthoracic echocardiology revealed a slight reduction of RV function. General anesthesia was induced and maintained by thiopental, remifentanil, sevoflurane, and rocuronium. PA pressure gradually increased after peritoneal insufflation; therefore, we administered dobutamine and nitroglycerin to decrease pulmonary vascular resistance (PVR). The patient emerged from anesthesia smoothly. Conclusions Avoiding increased PVR by appropriate anesthesia and medical hemodynamic support is an important consideration for patients with M-A PAH. 

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Anesthetic management of a patient with methamphetamine-associated pulmonary arterial hypertension undergoing laparoscopic cholecystectomy

Antidepressants and antipsychotics

Clinical practice guidelines for the assessment and management of elderly presenting with psychiatric emergencies

Background: Medical comorbidities are frequent in patients suffering from psychiatric disorders. Many of these patients would need emergency or elective surgeries in their lifetime. The perioperative period is a unique and critical phase, and thoughtful, informed management can prevent various medical misadventures in this period, thus improving the postoperative outcomes. Aim: This article attempts to provide an overview of the use of psychopharmacological agents during the perioperative period, the current recommendations about continuing or discontinuing various psychotropics in the perioperative period, and how to restart medications in the postsurgical period. Material and Methods: For this narrative review, literature search was done on PubMed and Google Scholar and relevant articles were identified and included. Results: For elective surgery, the psychiatrist should review the available investigation, severity of the physical illness, physical health status of the patient as per the American Society of Anaesthesiology (ASA) category, severity and stability of psychiatric disorder, comorbid substance use, and the ongoing psychotropics and their interactions with ongoing medications. In patients with ASA categories I and II, psychotropic medications can be continued. For patients with ASA categories V and VI, preferably psychotropics should be stopped. For patients belonging to ASA categories III and IV, antipsychotics except for clozapine can be continued; however, if feasible antidepressants and lithium should be stopped. For elective surgery, clozapine needs to be stopped 12 h before surgery, lithium 48–72 h before surgery, antidepressants to be tapered about 7–10 days before surgery, and monoamine oxidase inhibitors to be tapered and stopped 14 days before surgery. Other antipsychotics, mood stabilizers, and benzodiazepines can be continued till the day of surgery. When there is lack of time due to emergency surgery then a proper discussion with the primary team and the anesthetist need to be done about the possible risks. Conclusion: The psychiatrists handling patients in the perioperative period should have an idea about how psychotropics interact with different anesthetic agents and ensure that the anesthesiologist and the surgeon are made aware of the possible complications that might occur during the surgical and anesthetic procedure due to the concurrent use of specific psychotropics. 

Psychotropic medications around perioperative period: How to go about?

Psychotropic drugs are used in the treatment of psychiatric and non-psychiatric conditions. Many patients who are on psychotropic medications may present for procedures requiring anesthesia. Psychotropic medications can have dangerous interactions with drugs commonly used in anesthesia, some of which can be life-threatening. In this review, we describe the current anesthetic considerations for patients on psychotropic drug therapies, including antidepressants, antipsychotics, mood stabilizers, anxiolytics, and stimulants. The pharmacology, side effects, and potential drug interactions of the commonly prescribed psychotropic drug therapies with anesthetic agents are described. Further, we highlight the current recommendations regarding the cessation and continuation of these medications during the perioperative period.

Layne Bettini

Papers

Anesthetic Considerations for Patients on Psychotropic Drug Therapies