Effects of acetylcholinesterase inhibitor therapy for Alzheimer's disease on neuromuscular block

Baruah, Jitendra K.; Easby, J; Kessell, G.

doi:10.1093/bja/aen010

Cited by 17 publications

(9 citation statements)

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“…Anesthesiologists must also be aware of drug-drug interactions, such as the interaction between neuromuscular blocking agents and acetylcholinesterase inhibitors [57, 58]. Donepezil (Aricept), a commonly prescribed medication in AD, is a reversible non-competitive cholinesterase inhibitor.…”

Section: Main Bodymentioning

confidence: 99%

“…It has a half-life of approximately 72 h, and requires 2–3 weeks for complete wash out [59]. Published case reports demonstrate that patients on donepezil may exhibit high intraoperative requirements for non-depolarizing neuromuscular blockers including atracurium, rocuronium, and vecuronium [57, 60]. In contrast, prolonged paralysis has been described with administration of succinylcholine to a patient on donepezil, potentially due to reduced pseudocholinesterase inhibitor activity [58].…”

Section: Main Bodymentioning

confidence: 99%

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Anesthesiology and cognitive impairment: a narrative review of current clinical literature

2019

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Background: The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction. Main body: This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer's disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment. Conclusions: Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.

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Section: Main Bodymentioning

confidence: 99%

Section: Main Bodymentioning

confidence: 99%

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

2019

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“…-4 weeks before anaesthesia wherever possible. This should not have a detrimental effect on the patient's overall cognitive function, as anticholinesterases may have no disease modifying action 6. …”

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confidence: 99%

Changes in S100B levels rather than absolute values may be a better marker of severity of septic encephalopathy

Panni¹,

Panni²

2008

British Journal of Anaesthesia

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“…Baruah et al [5] also reported increased NDMR dose requirement with inadequate muscle relaxation intra-operatively in an elderly patient on donepezil. The above case reports are in concurrence with this case and support the possibility of donepezil being the agent responsible for the inadequate intra-operative and prolonged post-operative neuromuscular block.…”

Section: Discussionmentioning

confidence: 99%

Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery

Dharmavaram

Wadhawan

et al. 2011

J Anaesthesiol Clin Pharmacol

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A 74-year-old female with diabetes mellitus type II and Alzheimer's disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery.

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Effects of acetylcholinesterase inhibitor therapy for Alzheimer's disease on neuromuscular block

Cited by 17 publications

References 1 publication

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

Changes in S100B levels rather than absolute values may be a better marker of severity of septic encephalopathy

Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery

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