Pharmacological Interactions in the Perioperative Period

  • V. A. Peduto
  • R. D’Uva


Considering that patients admitted to a hospital are frequently given regular drug therapy (the incidence being 24%-42% overall and increasing to 70% in patients aged over 70 years) (1, 2), that each patient may receive on average 9.4 drugs during hospitalization (3), and, finally, that another ten or more drugs may be given for a “routine” anesthetic procedure, it is not surprising that the potential for perioperative drug interactions is very significant. Indeed, this risk has been estimated at 7% in patients taking six to ten drugs and 50% in patients taking more than ten drugs (4).


Drug Interaction Neuromuscular Blockade Free Fraction Liver Blood Flow Neuromuscular Blocking Agent 
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  1. 1.
    Duthie DJR, Montgomery JN, Spence AA, Nimmo WS (1987) Concurrent drug therapy in patients undergoing surgery. Anaesthesia 42:305–311PubMedCrossRefGoogle Scholar
  2. 2.
    Kluger MT, Gale S, Plummer JL, Owen H (1991) Perioperative drug prescribing pattern and manufacturers’ guidelines. Anaesthesia 46:456–459PubMedCrossRefGoogle Scholar
  3. 3.
    Lawson DH, Tick H (1976) Drug prescribing in hospitals: an international comparison. Am J Publ Health 66:644–648CrossRefGoogle Scholar
  4. 4.
    Dambro MR, Kallgren MA (1988) Drug interactions in a clinic using costar. Comput Biol Med 18:31–38PubMedCrossRefGoogle Scholar
  5. 5.
    Yuen IH, Denman SL, Sokoloski TD, Burkman LM (1979) Loss of nitroglycerin from aqueous solution into plastic intravenous delivery systems. J Pharm Sci 68:1163–1166PubMedCrossRefGoogle Scholar
  6. 6.
    Mutch WAC, Thomson IR (1983) Delivery systems for intravenous nitroglycerin. Can Anaesth Soc J 30:98–99PubMedCrossRefGoogle Scholar
  7. 7.
    Koren G, Goresky G, Crean P, Klein J, MacLeod SM (1984) Pediatric fentanyl dosing based on pharmacokinetics during cardiac surgery. Anesth Analg 63:577–582PubMedCrossRefGoogle Scholar
  8. 8.
    Cullen BF, Miller MG (1979) Drug interactions and anesthesia: a review. Anesth Analg 58:413–423PubMedGoogle Scholar
  9. 9.
    Hindle AT, Columb MO, Shah MV (1995) Drug interactions and anaesthesia. Curr Anaesth Crit Care 6:103–112CrossRefGoogle Scholar
  10. 10.
    Nimmo WS, Heading RC, Wilson J, Tothill P, Prescott LF (1975) Inhibition of gastric emptying and drug absorption by narcotic analgesics. Br J Clin Pharmacol 2:509–513PubMedGoogle Scholar
  11. 11.
    Gamble JAS, Gaston JH, Nair SG, Dundee JW (1976) Some pharmacological factors influencing the absorption of diazepam following oral administration. Br J Anaesth 48: 1181–1185PubMedCrossRefGoogle Scholar
  12. 12.
    Lasser EC, Elizondo-Martel G, Granke RC (1963) Potentiation of pentobarbital anaesthesia by competitive protein binding. Anesthesiology 24:665–671PubMedCrossRefGoogle Scholar
  13. 13.
    Kaukinen S, Eerola M, Ylitalo P (1980) Prolongation of thiopentone anaesthesia by probenecid. Br J Anaesth 52:603–607PubMedCrossRefGoogle Scholar
  14. 14.
    Csogor SI, Kerek SF (1970) Enhancement of thiopentone anaesthesia by sulphafurazole. Br J Anaesth 42:988–990PubMedCrossRefGoogle Scholar
  15. 15.
    Dale O, Nilsen OG (1984) Displacement of some basic drugs from human serum proteins by enflurane, halothane and their major metabohtes. Br J Anaesth 56:535–542PubMedCrossRefGoogle Scholar
  16. 16.
    Wood M (1986) Plasma drug binding: implications for anesthesiologists. Anesth Analg 65: 786–804PubMedGoogle Scholar
  17. 17.
    Ghoneim MM, Pandya H (1974) Plasma protein binding of bupivacaine and its interactions with other drugs in man. Br J Anaesth 46:435–438PubMedCrossRefGoogle Scholar
  18. 18.
    McLain GE, Sipes IG, Brown BR Jr (1979) An animal model of halothane hepatotoxicity: roles of enzyme induction and hypoxia. Anesthesiology 51:321–326PubMedCrossRefGoogle Scholar
  19. 19.
    Brown BR Jr, Sipes JC (1977) Biotransformation and hepatotoxicity of halothane. Biochem Pharmacol 26:2091–2094PubMedCrossRefGoogle Scholar
  20. 20.
    Mazze RI, Woodruff RE, Heerdt ME (1982) Isoniazid-induced enflurane defluorination in humans. Anesthesiology 57:5–8PubMedCrossRefGoogle Scholar
  21. 21.
    Sorkin EM, Ogawa GS (1981) Cimetidine potentiation of narcotic action. Drug Intell Clin Pharm 17:60–61Google Scholar
  22. 22.
    Lam AM (1981) Potentially lethal interaction of cimetidine and morphine. Can Med Assoc J 125:820PubMedGoogle Scholar
  23. 23.
    Klotz U, Reimann I (1980) Delayed clearance of diazepam due to cimetidine. N Engl J Med 302:1012–1014PubMedCrossRefGoogle Scholar
  24. 24.
    Salonen M, Aantaa E, Aaltonen L (1986) Importance of the interaction of midazolam and cimetidine. Acta Pharmacol Toxicol 56:91–95Google Scholar
  25. 25.
    Freely J, Wilkinson Gr, Wood AJJ (1981) Reduction of liver blood flow and propranolol metabohsm by cimetidine. N Engl J Med 304: 692–695CrossRefGoogle Scholar
  26. 26.
    Knapp AB, Maguire W, Keren G, Karmen A, Levitt B, Miura DS, Somberg JC (1983) The cimetidine-lidocaine interaction. Ann Intern Med 98:174–177PubMedGoogle Scholar
  27. 27.
    Campbell MA, Plachetka JR, Jackson JE (1981) Cimetidine decreases theophylhne clearance. Ann Intern Med 95:68–69PubMedGoogle Scholar
  28. 28.
    Hansen WE, Berti S (1983) The inhibition of acetylchohnesterase and pseudochohnesterase by cimetidine. Arzneimittelforschung 33:161–163PubMedGoogle Scholar
  29. 29.
    Kambam JR, Dymond R, Krestow M (1987) Effect of cimetidine on duration of action of succinylchohne. Anesth Analg 66:191–192PubMedCrossRefGoogle Scholar
  30. 30.
    Stirt AJ, Sperry RJ, DiFazio CA (1988) Cimetidine and succinylchohne: potential interactions and effect on neuromuscular blockade in man. Anesthesiology 69:607–608PubMedCrossRefGoogle Scholar
  31. 31.
    Whittaker M (1980) Plasma Cholinesterase variants and the anaesthetist. Anaesthesia 35: 174–197PubMedCrossRefGoogle Scholar
  32. 32.
    Viby-Mogensen J (1983) Cholinesterase and succinylchohne. Dan Med Bull 30:129–150PubMedGoogle Scholar
  33. 33.
    Rogers KJ, Thornton JA (1969) The interaction between monoamine oxidase inhibitors and narcotic analgesics in mice. Br J Pharmacol 36:470–480PubMedGoogle Scholar
  34. 34.
    Gibb D (1984) Drug interactions in anaesthesia. Clin Anaesthesiol 2:485–512Google Scholar
  35. 35.
    Janowsky EC, Risch SC, Janowsky DS (1986) Psychotropic agents. In: Smith NT, Corbascio AN (eds) Drug interactions in anesthesia. Lea and Febiger, Philadelphia, pp 261–281Google Scholar
  36. 36.
    Stoeckel H, Hengstmann JH, Schuttler J (1979) Pharmacokinetics of fentanyl as a possible explanation for recurrence of respiratory depression. Br J Anaesth 51:741–745PubMedCrossRefGoogle Scholar
  37. 37.
    Calvey TN, Milne LA, Williams NE, Chan K, Murray GR (1983) Effect of antacids on the plasma concentration of phenoperidine. Br J Anaesth 55:535–539PubMedCrossRefGoogle Scholar
  38. 38.
    Johnston RR, Eger II EI, Wilson CA (1976) A comparative interaction of epinephrine with enflurane, isoflurane, and halothane in man. Anesth Analg 55:709–712PubMedCrossRefGoogle Scholar
  39. 39.
    Atlee JL, Roberts FL (1986) Thiopental and epinephrine-induced dysrhythmias in dogs anesthetized with enflurane or isoflurane. Anesth Analg 65:437–443PubMedCrossRefGoogle Scholar
  40. 40.
    Horrigan RW, Eger II EI, Wilson CW (1978) Epinephrine-induced arrhythmias during enflurane anesthesia in man: a nonlinear dose-response relationship and dose-dependent protection from lidocaine. Anesth Analg 57:547–550PubMedGoogle Scholar
  41. 41.
    Nakao S, Hirata H, Kagawa Y (1989) Effects of volatile anesthetics on cardiac calcium channels. Acta Anaesthesiol Scand 33:326–330PubMedCrossRefGoogle Scholar
  42. 42.
    Durand PG, Lehot JJ, Foex P (1991) Calcium-channel blockers and anaesthesia. Can J Anaesth 38:75–89PubMedCrossRefGoogle Scholar
  43. 43.
    Atlee JL, Hamann SR, Brownlee SW, Kreigh C (1988) Conscious state comparisons of the effects of the inhalation anesthetics and diltiazem, nifedipine, or verapamil on specialized atrioventricular conduction times in spontaneously beating dog hearts. Anesthesiology 68: 519–528PubMedCrossRefGoogle Scholar
  44. 44.
    Quist Christensen L, Bonde J, Kampmann JP (1993) Drug interactions with inhalational anaesthetics. Acta Anaesthesiol Scand 37:231–244CrossRefGoogle Scholar
  45. 45.
    Prys-Roberts C (1980) Cardiovascular effects of beta-receptor antagonists during anaesthesia. In: Prys-Roberts C (ed) The circulation in anaesthesia, applied physiology and pharmacology. Blackwell Scientific, Oxford, pp 406–428Google Scholar
  46. 46.
    Philbin DM, Lowenstein E (1976) Lack of beta-adrenergic activity of isoflurane in the dog: a comparison of the circulatory effects of halothane and isoflurane after propranolol administration. Br J Anaesth 48:1165–1170PubMedCrossRefGoogle Scholar
  47. 47.
    Sprague DH (1975) Severe bradycardia after neostigmine in a patient taking propranolol to control paroxysmal atrial tachycardia. Anesthesiology 42:208–210PubMedCrossRefGoogle Scholar
  48. 48.
    Wolfson B, Freed B (1980) Influence of alcohol on anesthetic requirements and acute toxicity. Anesth Analg 59:826–830PubMedCrossRefGoogle Scholar
  49. 49.
    Bruce DL (1983) Alcohohsm and anesthesia. Anesth Analg 62:84–96PubMedGoogle Scholar
  50. 50.
    White PF (1982) Comparative evaluation of intravenous agents for rapid sequence induction — thiopental, ketamine, and midazolam. Anesthesiology 57:279–284PubMedCrossRefGoogle Scholar
  51. 51.
    Tomicheck RC, Rosow CE, Philbin DM, Moss J, Teplick RS, Schneider RC (1983) Diazepam-fentanyl interaction. Hemodynamic and hormonal effects in coronary artery surgery. Anesth Analg 62:881–884PubMedCrossRefGoogle Scholar
  52. 52.
    Bidwai AV, Stanley TH, Graves CL, Kawamura R, Sentker CR (1975) The effects of ketamine on cardiovascular dynamics during halothane and enflurane anesthesia. Anesth Analg 54: 588–592PubMedGoogle Scholar
  53. 53.
    Salmenpera M, Peltola K, Takkunen O, Heinonen J (1983) Cardiovascular effects of pancuronium and vecuronium during high-dose fentanyl anesthesia. Anesth Analg 62: 1059–1064PubMedGoogle Scholar
  54. 54.
    Ostergaard D, Engbaek J, Viby-Mogensen J (1989) Adverse reactions and interactions of the neuromuscular blocking drugs. Med Toxicol Adverse Drug Exp 4:351–368PubMedGoogle Scholar
  55. 55.
    Fiekers JF (1983) Effects of the aminoglycoside antibiotics, streptomycin and neomycin, on neuromuscular transmission. J Pharmacol Exp Ther 225:487–495PubMedGoogle Scholar
  56. 56.
    Singh YN, Marshall IG, Harvey AL (1982) Pre- and post-junctional blocking effects of aminoglycoside, polymyxin, tetracycline and lincosamide antibiotics. Br J Anaesth 54: 1295–1306PubMedCrossRefGoogle Scholar
  57. 57.
    Ghoneim MM, Long JP (1970) The interaction between magnesium and other neuromuscular blocking agents. Anesthesiology 32: 23–27PubMedCrossRefGoogle Scholar
  58. 58.
    Hill GE, Wong KC, Hodges MR (1977) Lithium carbonate and neuromuscular blocking agents. Anesthesiology 46:122–126PubMedCrossRefGoogle Scholar
  59. 59.
    Laflin MJ (1977) Interaction of pancuronium and corticosteroids. Anesthesiology 47:471–472PubMedCrossRefGoogle Scholar
  60. 60.
    Ghsson SN, El-Etr A, Lim R (1979) Prolongation of pancuronium-induced neuromuscular blockade by intravenous infusion of nitroglycerin. Anesthesiology 51:47–49CrossRefGoogle Scholar
  61. 61.
    Dretchen KL, Morgenroth III VH, Standaert EG, Walts LF (1976) Azathioprine: effects on neuromuscular transmission. Anesthesiology 45:604–609PubMedCrossRefGoogle Scholar
  62. 62.
    Gramstad L, Gjerlow JA, Hysing ES, Rugstad HE (1986) Interaction of cyclosporin and its solvent, cremophor, with atracurium and vecuronium. Studies in the cat. Br J Anaesth 58: 1149–1155PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • V. A. Peduto
  • R. D’Uva

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