Expert: Ronald Levy, M.D. - 1/6/2007

Question
I need to undergo knee surgery to replace my ACL and repair other damage to my knee. I have used Nardil, an MAOI, for about 20 years, to great benefit. I have been informed by several doctors that, if I stop taking Nardil prior to surgery, the beneficial effects of the drug will probably not be recaptured when I resume the medication. Since I do not want to take that risk, I have two questions. First, is it possible to perform extensive knee surgery using only local anesthetic on the patient? Since this sounds a bit frightening and medieval, my second question what is the nature and extent of the risk of surgery with a patient on Nardil, what can be done to lessen the risks. If you could be specific about the names of anesthetics and other drugs that should be avoided or relied on, I would appreciate this information as I consult with the anesthesiologist prior to surgery. Thank you very much for providing this invaluable service.

Answer
Knee surgery such as yours can be done under regional (spinal or epidural) or general. In any of the cases, as long as we know you are on MAOIs, we know how to manage any problems that occur. I'm not going to mention all the meds we will use but I'm sure your anesthesiologist will be happy to go ver them with you.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston