Implications of Perioperative Polypharmacy in Adolescents Undergoing Bariatric Surgery: a Single-Center Experience
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BRIEF COMMUNICATION
Implications of Perioperative Polypharmacy in Adolescents Undergoing Bariatric Surgery: a Single-Center Experience Elaine F. Williams 1 & Janelle D. Vaughns 1,2 Johannes N. van den Anker 1,6
&
Eleanor R. Mackey 3 & Jane C. Muret 4 & Evan P. Nadler 5 &
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Adolescents seeking bariatric surgery may present with pre-existing psychiatric diagnoses for which they use chronic medications. To heighten awareness concerning perioperative polypharmacy in adolescents with extreme obesity, we conducted a retrospective review of patients undergoing laparoscopic sleeve gastrectomy between February 2010 and May 2017 at Children’s National Health System (CNHS). A total of 167 adolescent patients had pre-existing psychiatric diagnoses which included depression (50%), anxiety (23%), ADHD (23%), and binge eating disorder (11%). Medications prescribed to treat these diagnoses included selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Additionally, all patients were given fentanyl, ondansetron, morphine, and acetaminophen perioperatively. Although no life threatening symptoms of drug-drug interactions (DDIs) were appreciated, the combined use of many different potent drugs in these patients warrants attention. Keywords Obesity . Adolescents . Bariatric surgery . Drug interactions . Depression . Selective . Serotonin uptake inhibitors . Serotonin-norepinephrine reuptake inhibitors
Introduction Adolescents who seek bariatric surgery are more likely to have preoperative psychiatric diagnoses [1]. In a retrospective review of youth undergoing bariatric surgery, it was reported Elaine F. Williams and Janelle D. Vaughns contributed equally to this work. * Janelle D. Vaughns [email protected]
that 30% had clinically significant symptoms of depression [2]. Depression is often treated with selective serotonin uptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants [3]. The purpose of this brief communication is to alert physicians concerning clinically relevant drug-drug interactions (DDIs) during and after adolescent bariatric surgery.
Methods We conducted a retrospective review using our IRB approved Bariatric Surgery Research Registry at CNHS. Adolescent patients who underwent laparoscopic sleeve gastrectomy (LSG) from February 2010 to May 2017 were included. All pre-existing diagnoses and medications administered prior to and during the perioperative stay were reviewed. The perioperative period was approximately 3 days, extending from the time of surgery to the day of discharge. See Table 1 for the complete listing of perioperative prescribed drugs.
1
Division of Clinical Pharmacology, Children’s National Hospital, Washington, DC, USA
2
Department of Anesthesiology, Sedation & Perioperative Medicine, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010, USA
3
Division of Psychology, Childr
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