Safety of Anaesthetic Drugs

Abstract

This short book is a compilation of four review articles published in 1997 and 1998 in CNS Drugs and Drug Safety. The main objective of the book is to discuss the clinically significant drug interactions and adverse effects of most commonly used anaesthetic drugs. However, in the foreword the editor points out that drug interactions with neuromuscular blockers are not included ‘… because of the availability of recent reviews on this topic’. I found this a little odd, since the book itself is a collection of recent reviews. Each chapter is exhaustively referenced, as you might expect from a series of review articles, to the extent that there are just over 30 pages of references out of a total of 101. There are also 29 tables and figures. The first chapter, on adverse effects of general anaesthetics, contains a classification of adverse drug reactions and systematically covers the effects of commonly used anaesthetics on the various organs and systems. The next chapter covers the incidence, mechanism and management of clinically significant drug interactions with general anaesthetics. There are a number of tables summarising the pharmacokinetic and pharmacodynamic interactions between anaesthetic drugs and classes of drugs (rather than specific drugs) which patients may be taking or require in the peri-operative period. These tables include the mechanism and suggested management of the interaction, and provide a useful summary for those of us who find these facts hard to remember. The third chapter covers the adverse effects of neuromuscular blockers and their antagonists, but not their interactions. As with the first chapter this is divided into the effects on the various organs and systems. The final chapter covers the adverse effects and drug interactions associated with local and regional anaesthesia. Again the logical progression through the systems takes place, with discussion of the features, mechanism and treatment of the adverse effects. Finally there are tables of the pharmacokinetic and pharmacodynamic interactions of local anaesthetics, as in the second chapter. I have never found pharmacology texts particularly readable, and this one is no exception, because of the prodigious number of facts on each page. I was given the book to read at the same time as trying to find the answers to some recent Primary FRCA multiple choice questions. I found that as long as the question was within the scope of the articles, the answer was usually there. This brings me to my main criticism of the book. As far as it goes it is informative, but it doesn't cover (apart from the involvement in interactions) any of the drugs which we use which are not anaesthetics. Exam candidates and practising anaesthetists alike still need to know about the safety of premedicants, sedatives, opioids, anti-emetics, antibiotics, inotropes and vasodilators to name but a few. For this reason, I am uncertain whether this book has a niche in an already crowded market.