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Carol A. Hirshman, MD; Karen S. Lindeman, MD
The Johns Hopkins University School of Medicine Baltimore, Md

JAMA. 1989;261(23):3407-3408.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

Dr Gevirtz's letter expresses the traditional sentiment regarding discontinuation of monoamine oxidase inhibitors (MAOIs) 2 to 3 weeks prior to elective surgery because of cardiovascular instability and central nervous system dysfunction during anesthesia. However, a growing awareness of the relative safety of these agents has led several authors to question this policy.^1-3

In the past, many classes of drugs, including β-blockers and calcium channel blockers, have been discontinued in patients prior to elective surgery. In most cases, this practice stemmed from isolated case reports of adverse reactions in patients in uncontrolled circumstances. This practice did not withstand controlled scientific studies and, currently, virtually all long-term medications, with the exception of MAOIs, are routinely continued in the perioperative period. We believe that it is now time to reevaluate our past opinions with regard to MAOIs.

Although a wealth of scientific evidence is not available, we refer Dr Gevirtz, . . . [Full Text PDF of this Article]

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