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Drug interactions and the clinical anaesthetist

Dawson, J.; Karalliedde, L.

European Journal of Anaesthesiology: March 1998 - Volume 15 - Issue 2 - p 172-189
Original Papers
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In clinical practice, anaesthetists encounter many patients who are on concurrent medication which may have the potential to interact with drugs used during anaesthesia. Many patients are receiving as many as a dozen drugs of various kinds, thus, increasing the risk of a drug interaction occurring. Unfortunately, anaesthetists tend not to report drug interactions which occur during anaesthesia-especially those of a minor nature such as flushing-and hence, the true number of drug interactions is unknown. We have developed a chart indicating the nature of important interactions that the anaesthetist may encounter.

Department of Anaesthetics, UMDS, London SE1 9RT, UK

Accepted October 1997

Correspondence: L. D. Karalliedde.

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Introduction

Interactions due to drugs administered to patients are graded as:

  • Hazardous interaction: when the drug combination should be avoided.
  • Interaction of note: where the drug combination can have the potential to cause severe disturbances.
  • Possible interaction: where there is a possibility of an interaction taking place either as a result of theoretical factors or because of the pharmacological profiles of the drugs.
  • Beneficial interaction: where a drug combination is used to produce a useful and advantageous result for the patient.

Drugs included in the category of hazardous interactions are those which have been well documented in the medical literature and have caused life-threatening incidents. Interactions of note are those where disturbances have been reported and where caution is necessary when the combinations are used. A possible interaction is one which is known to cause minor to moderate changes in physiological function and clinicians should be aware that an interaction of any severity is possible should these drugs be used again. This work has been compiled by searching the literature on drug interactions of interest in anaesthetic practice. These interactions are found in Table 1.

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

Table 1

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Conclusion

We have made an attempt to categorize drug interactions by considering all the information available to us. The interpretation of an interaction as hazardous, or otherwise, is difficult because there is an element of personal judgement.

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                                                              Keywords:

                                                              Drug interactions; anaesthesia

                                                              © 1998 European Society of Anaesthesiology