ANESTHESIA IN PATIENTS WITH PSYCHIATRIC DISORDERS: CLINICAL IMPLICATIONS, PHARMACOLOGICAL INTERACTIONS, AND CHALLENGES IN PERIOPERATIVE SAFETY

Abstract

Psychiatric disorders affect up to one quarter of surgical patients, bringing to the operating room a set of clinical and ethical challenges that arise from complex interactions between psychotropic and anesthetic agents. Chronic use of antidepressants, antipsychotics, mood stabilizers, and anxiolytics modifies cardiovascular, neurological, and respiratory responses, increasing perioperative risks and exposing the lack of specific protocols. The aim of this study was to critically analyze the implications of anesthesia in patients with psychiatric disorders, with emphasis on pharmacological interactions and patient safety. An integrative review was conducted in PubMed/MEDLINE and BVS databases, covering articles published between 2019 and 2025, in English, open access, involving humans and classified as clinical trials, systematic reviews, meta-analyses, or randomized clinical trials. After screening and duplicate removal, 25 studies were included. Results showed a 1.4-fold higher risk of perioperative complications, 22% longer hospital stay, and up to 1.5-fold higher mortality in this population. Documented risks included doubled bleeding in SSRI users, prolonged neuromuscular blockade in patients under lithium, and high lethality of neuroleptic malignant syndrome. We conclude that anesthetizing psychiatric patients requires multiprofessional integration and the urgent formulation of national protocols to ensure safe, ethical, and humanized care.