Perioperative Drug Interactions - What Should Be Considered by Anesthetists

Abstract

Drug interactions cause numerous hospital admissions and even death. Administration of multiple therapeutic drugs increases the risk of relevant interactions. Pharmacologist consultation and also IT-based drug-interaction examination focus on this risk and may improve the safety and quality of the medical therapy. The perioperative period as well as for example post-surgery intensive care display a high-risk period for critical drug interactions because of the increased number of administered drugs at this time. This is highly challenging to the acting anesthetist. A detailed knowledge on possible drug-interactions is indispensable to maintain the highest duty of our faculty: patient's safety.Thus on the one hand modern narcosis uses drug interactions in performing "balanced anesthesia" and on the other hand it is essential to know about unwanted interactions that might arise of several mechanisms like chemical interactions as well as pharmacokinetic and pharmacodynamic ways. In this context, phenomena as the pharmaceutic influence on the QT-time have to be known as well as the so called serotonine syndrome for example. A detailed insight into the metabolism of administered drugs including elimination pathways like p-glycoprotein or enzymes of the cytochrome-p-450 family is helpful to maintain a basic survey.