•This case involved a 78-year-old male presenting for a laparoscopic cholecystectomy.

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•The patient is a non-smoker and was noted to have a history of post-operative nausea and vomiting (PONV) and motion-sickness.

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•This patient’s past medical history includes Parkinson’s disease diagnosed 9 years ago.

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•He reports good functional status and that his Parkinson’s symptoms are well-controlled on carbidopa/levodopa (Sinemet) and selegiline (Eldepryl).

•Pre-operatively, the patient’s possible medication interactions were reviewed carefully in consideration this patient’s age group and home medications.

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•The decision was made to utilize total intravenous anesthesia (TIVA) to reduce his risk of PONV, prophylactic dexamethasone after induction, and ondansetron to treat any symptoms postoperatively. 

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•The patient had an uneventful intraoperative and postoperative course and made a full recovery without interruption of his current medication regimen.

•The management of Parkinson's patients during the perioperative period can be challenging and result in medical complications, prolonged hospital stays, and delayed recovery.1

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•Many commonly used anti-nausea medications have anti-dopaminergic activity that can exacerbate the symptoms of PD and prolong patient’s post-operative recovery time.

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•Given that most PD patients are over age 60, medications that have anticholinergic or GABAergic properties should also be avoided if possible.

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•Lastly, patients taking MAOIs are at risk of serotonin toxicity, also known as serotonin syndrome, when other serotonin reuptake inhibitors (SRI) are administered.

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•Although Ondansetron (Zofran) has historically been labeled as a drug to avoid in patients taking MOAi’s, its 5-HT3 antagonism does not significantly increase serotonin levels in the body, therefore it does not increase the risk of serotonin toxicity.3

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•This case investigates the reality and myths of anesthetic risks of MAOi’s in the perioperative period and elucidates the misconceptions of the usage of ondansetron in patients on MAOi’s with PONV.

1. Katus L, Shtilbans A. Perioperative management of patients with Parkinson's disease. Am J Med. 2014 Apr;127(4):275-80. doi: 10.1016/j.amjmed.2013.11.014. Epub 2013 Dec 11. PMID: 24333200.

2.Rosenbaum HK, Van den Eynde V, Gillman PK. Expert Opinion on Anesthetic Considerations For Patients Receiving a Classic Monoamine Oxidase Inhibitor. Anesthesia & Analgesia 2022;10.1213