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3 - Drug Interactions: Additivity and Synergy among Anaesthetic Drugs

from Section 1 - Basic Principles

Published online by Cambridge University Press:  03 December 2019

By
Jacqueline A. Hannam  and
Timothy G. Short
Edited by
Pedro L. Gambús  and
Jan F. A. Hendrickx
Pedro L. Gambús
Affiliation:
Hospital Clinic de Barcelona, Spain
Jan F. A. Hendrickx
Affiliation:
Aalst General Hospital, Belgium
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Summary

Modern anaesthesia and sedation consists of giving combinations of hypnotic and analgesic drugs to obtain the desired anaesthetic effect. Understanding how these drugs interact to create the anaesthetic state improves the precision of anaesthetic drug dosing and physiological stability of the patient.

Type
Chapter
Information
Personalized Anaesthesia
Targeting Physiological Systems for Optimal Effect
 , pp. 29 - 39
Publisher: Cambridge University Press
Print publication year: 2020

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References

Lichtenbelt, BJ, Olofsen, E, Dahan, A, van Kleef, JW, Struys, MMRF, Vuyk, J: Propofol reduces the distribution and clearance of midazolam. Anesth.Analg. 2010; 110(6): 1597–606.Google Scholar
Vuyk, J, Lichtenbelt, BJ, Olofsen, E, van Kleef, JW, Dahan, A: Mixed-effects modeling of the influence of midazolam on propofol pharmacokinetics. Anesth.Analg. 2009; 108(5): 1522–30.Google Scholar
Mertens, MJ, Vuyk, J, Olofsen, E, Bovill, JG, Burm, AG: Propofol alters the pharmacokinetics of alfentanil in healthy male volunteers. Anesthesiology. 2001; 94(6): 949–57.CrossRefGoogle ScholarPubMed
Manyam, SC, Gupta, DK, Johnson, KB, White, JL, Pace, NL, Westenskow, DR, et al: Opioid-volatile anesthetic synergy: a response surface model with remifentanil and sevoflurane as prototypes. Anesthesiology. 2006; 105(2): 267–78.Google Scholar
Loewe, S: The problem of synergism and antagonism of combined drugs. Arzneimittelforschung. 1953; 3(6): 285–90.Google ScholarPubMed
Short, TG, Chui, PT: Propofol and midazolam act synergistically in combination. Br.J.Anaesth. 1991; 67(5): 539–45.Google Scholar
Kissin, I, Vinik, HR, Bradley, EL, Jr.: Midazolam potentiates thiopental sodium anesthetic induction in patients. J.Clin.Anesth. 1991; 3(5): 367–70.Google Scholar
Hill, A: The possible effects of the aggregation of the molecules of haemoglobin on its dissociation curves. J.Physiol. 1910; 40(Suppl): i–vii.Google Scholar
Greco, WR, Park, HS, Rustum, YM: Application of a new approach for the quantitation of drug synergism to the combination of cis-diamminedichloroplatinum and 1-beta-D-arabinofuranosylcytosine. Cancer Res. 1990; 50(17): 5318–27.Google Scholar
Minto, CF, Schnider, TW, Short, TG, Gregg, KM, Gentilini, A, Shafer, SL: Response surface model for anesthetic drug interactions. Anesthesiology. 2000; 92(6): 1603–16.Google Scholar
Bouillon, TW, Bruhn, J, Radulescu, L, Andresen, C, Shafer, TJ, Cohane, C, et al: Pharmacodynamic interaction between propofol and remifentanil regarding hypnosis, tolerance of laryngoscopy, bispectral index, and electroencephalographic approximate entropy. Anesthesiology. 2004; 100(6): 1353–72.CrossRefGoogle ScholarPubMed
Mertens, MJ, Olofsen, E, Engbers, FH, Burm, AG, Bovill, JG, Vuyk, J: Propofol reduces perioperative remifentanil requirements in a synergistic manner: response surface modeling of perioperative remifentanil-propofol interactions. Anesthesiology. 2003; 99(2): 347–59.Google Scholar
Heyse, B, Proost, JH, Schumacher, PM, Bouillon, TW, Vereecke, HE, Eleveld, DJ, et al: Sevoflurane remifentanil interaction: comparison of different response surface models. Anesthesiology. 2012; 116(2): 311–23.Google Scholar
Short, TG, Ho, TY, Minto, CF, Schnider, TW, Shafer, SL: Efficient trial design for eliciting a pharmacokinetic-pharmacodynamic model-based response surface describing the interaction between two intravenous anesthetic drugs. Anesthesiology. 2002; 96(2): 400–8.CrossRefGoogle ScholarPubMed
LaPierre, CD, Johnson, KB, Randall, BR, White, JL, Egan, TD, Yang, L, et al: An exploration of remifentanil-propofol combinations that lead to a loss of response to esophageal instrumentation, a loss of responsiveness, and/or onset of intolerable ventilatory depression. Anesth.Analg. 2011; 113(3): 441–3.Google Scholar
Vuyk, J, Lim, T, Engbers, FH, Burm, AG, Vletter, AA, Bovill, JG: The pharmacodynamic interaction of propofol and alfentanil during lower abdominal surgery in women. Anesthesiology. 1995; 83(1): 8–22.CrossRefGoogle ScholarPubMed
McClune, S, McKay, AC, Wright, PM, Patterson, CC, Clarke, RS: Synergistic interaction between midazolam and propofol. Br.J.Anaesth. 1992; 69(3): 240–5.Google Scholar
Short, TG, Plummer, JL, Chui, PT: Hypnotic and anaesthetic interactions between midazolam, propofol and alfentanil. Br.J.Anaesth. 1992; 69(2): 162–7.CrossRefGoogle ScholarPubMed
Short, TG, Galletly, DC, Plummer, JL: Hypnotic and anaesthetic action of thiopentone and midazolam alone and in combination. Br.J.Anaesth. 1991; 66(1): 13–19.Google Scholar
McAdam, LC, MacDonald, JF, Orser, BA: Isobolographic analysis of the interactions between midazolam and propofol at GABA(A) receptors in embryonic mouse neurons. Anesthesiology. 1998; 89(6): 1444–54.CrossRefGoogle ScholarPubMed
Ben-Shlomo, I, Abd-el-Khalim, H, Ezry, J, Zohar, S, Tverskoy, M: Midazolam acts synergistically with fentanyl for induction of anaesthesia. Br.J.Anaesth. 1990; 64(1): 45–7.Google Scholar
Kern, SE, Xie, G, White, JL, Egan, TD: A response surface analysis of propofol-remifentanil pharmacodynamic interaction in volunteers. Anesthesiology. 2004; 100(6): 1373–81.CrossRefGoogle ScholarPubMed
Syroid, ND, Johnson, KB, Pace, NL, Westenskow, DR, Tyler, D, Bruhschwein, F, et al: Response surface model predictions of emergence and response to pain in the recovery room: an evaluation of patients emerging from an isoflurane and fentanyl anesthetic. Anesth.Analg. 2010; 111(2): 380–6.Google Scholar
Hannivoort, LN, Vereecke, HEM, Proost, JH, Heyse, BEK, Eleveld, DJ, Bouillon, TW, et al: Probability to tolerate laryngoscopy and noxious stimulation response index as general indicators of the anaesthetic potency of sevoflurane, propofol, and remifentanil. Br.J.Anaesth. 2016; 116(5): 624–31.CrossRefGoogle ScholarPubMed
Katoh, T, Suguro, Y, Kimura, T, Ikeda, K: Cerebral awakening concentration of sevoflurane and isoflurane predicted during slow and fast alveolar washout. Anesth.Analg. 1993; 77(5): 1012–17.Google Scholar
Katoh, T, Kobayashi, S, Suzuki, A, Iwamoto, T, Bito, H, Ikeda, K: The effect of fentanyl on sevoflurane requirements for somatic and sympathetic responses to surgical incision. Anesthesiology. 1999; 90(2): 398–405.CrossRefGoogle ScholarPubMed
Katoh, T, Ikeda, K: The effects of fentanyl on sevoflurane requirements for loss of consciousness and skin incision. Anesthesiology. 1998; 88(1): 18–24.Google Scholar
Murray, DJ, Mehta, MP, Forbes, RB, Dull, DL. Additive contribution of nitrous oxide to halothane MAC in infants and children. Anesth.Analg. 1990; 71(2): 120–4.Google Scholar
Stevens, MD, Wendell, C, Dolan, MD, William, M, Gibbons, MD, Robert, T, White, MSA, Eger, MD, Edmond, I, Miller, MD, Ronald, D, et al: Minimum alveolar concentrations (MAC) of isoflurane with and without nitrous oxide in patients of various ages. Anesthesiology. 1975; 42(2): 197–200.Google Scholar
Hendrickx, JFA, Eger, EI, Sonner, JM, Shafer, SL: Is synergy the rule? A review of anesthetic interactions producing hypnosis and immobility. Anesth.Analg. 2008; 107(2): 494–506.Google Scholar
Hong, W, Short, TG, Hui, TW: Hypnotic and anesthetic interactions between ketamine and midazolam in female patients. Anesthesiology. 1993; 79(6): 1227–32.Google Scholar
Hui, TW, Short, TG, Hong, W, Suen, T, Gin, T, Plummer, J: Additive interactions between propofol and ketamine when used for anesthesia induction in female patients. Anesthesiology. 1995; 82(3): 641–8.CrossRefGoogle ScholarPubMed
Coulter, FL, Hannam, JA, Anderson, BJ: Ketofol simulations for dosing in pediatric anesthesia. Paediatr.Anaesth. 2014; 24(8): 806–12.Google Scholar
Katoh, T, Ikeda, K, Bito, H: Does nitrous oxide antagonize sevoflurane-induced hypnosis? Br.J.Anaesth. 1997; 79(4): 465–8.Google Scholar
Short, TG, Hannam, JA, Laurent, S, Campbell, D, Misur, M, Merry, AF, et al: Refining target-controlled infusion: an assessment of pharmacodynamic target-controlled infusion of propofol and remifentanil using a response surface model of their combined effects on bispectral index. Anesth.Analg. 2016; 122(1): 90–7.Google Scholar
Liu, N, Chazot, T, Hamada, S, Landais, A, Boichut, N, Dussaussoy, C, et al: Closed-loop coadministration of propofol and remifentanil guided by bispectral index: a randomized multicenter study. Anesth.Analg. 2011; 112(3): 546–57.Google Scholar
Agarwal, J, Puri, GD, Mathew, PJ: Comparison of closed loop vs. manual administration of propofol using the bispectral index in cardiac surgery. Acta Anaesthesiol.Scand. 2009; 53(3): 390–7.Google Scholar
Puri, GD, Mathew, PJ, Biswas, I, Dutta, A, Sood, J, Gombar, S, et al: A multicenter evaluation of a closed-loop anesthesia delivery system: a randomized controlled trial. Anesth.Analg. 2016; 122(1): 106–14.Google Scholar
Hemmerling, TM, Charabati, S, Zaouter, C, Minardi, C, Mathieu, PA: A randomized controlled trial demonstrates that a novel closed-loop propofol system performs better hypnosis control than manual administration. Can.J.Anaesth. 2010; 57(8): 725–35.CrossRefGoogle ScholarPubMed
Struys, MM, De Smet, T, Versichelen, LF, Van De Velde, S, Van den Broecke, R, Mortier, EP: Comparison of closed-loop controlled administration of propofol using bispectral index as the controlled variable versus “standard practice” controlled administration. Anesthesiology. 2001; 95(1): 6–17.Google Scholar

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