Drug interactions with inhalational anaesthetics

Abstract

The literature concerning the interactions between volatile anaesthetics, nitrous oxide and other compounds is reviewed. The majority are well known and most can be managed by careful dosage of the anaesthetics. The following interactions should be stressed since these are less predictable or potentially fatal. Of the cardiovascular drugs mainly the Ca++ channel blockers require attention. The volatile anaesthetics act synergistically with these drugs on the inhibition of cardiac conduction and may induce cardiac arrest. Aminoglycoside therapy should prompt an alternative to enflurane because of increased nephrotoxicity with this combination. Thiopentone induction makes the dog heart more susceptible to arrhythmias, especially during anaesthesia with volatile anaesthetics. Probably pentobarbitone, etomidate or a benzodiazepine should be preferred as an alternative to thiopentone when the use of adrenergic drugs peroperatively is anticipated. Nitrous oxide augments the sequelae after coronary air emboli and impaired cerebral perfusion in animals. The necessity of this drug should therefore be considered when anaesthetizing patients undergoing open heart surgery and patients with severe carotid or cerebral arteriosclerosis.

In vivo assessment of myocardial blood flow in rat heart using magnetic resonance imaging: Effect of anesthesia

“…In the present study, nitrous oxide was used as carrier gas because of its ability to hasten induction and recovery and because of its analgesic property (17). To address the possible contribution of N 2 O to the MBF increase observed under isoflurane anesthesia, a group of pentobarbital‐anesthetized rats were given this carrier gas to breathe.…”

“…The carrier gas for isoflurane could also influence MBF and LV function. In addition to oxygen (O 2 ), nitrous oxide (N 2 O) is commonly used because of its analgesic property and because it allows the decrease of the minimum alveolar concentration of administered volatile anesthetics, thereby minimizing their cardiodepressant effect as demonstrated in humans (17). Nitrous oxide has been shown to increase cerebral blood flow in the rat (18), in other animal species (19), and in humans (20).…”

Anaesthesia in Cosmetic Surgery: European Prospective

“…Various studies on humans and animals have shown signifi cant undesirable interaction between epinephrine and tricyclic antidepressants [ 32 ], β-blockers, especially non-selective [ 33 ], some halogenated anaesthetics [ 34 ], and barbiturates such as Pentothal sodium [ 35 ] (Table 3 ).…”

Aminoglycoside Antibiotics

“…The combined use of aminoglycosides and enflurane has been associated with an increased risk of nephrotoxicity (Christensen et al, 1993).…”