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Drugs & Aging

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01.11.2003 | Review Article

Clinically Important Drug Interactions with Intravenous Anaesthetics in Older Patients

verfasst von: Dr Helge Eilers, Claus U. Niemann

Erschienen in: Drugs & Aging | Ausgabe 13/2003

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Abstract

There is a continuously growing population of older surgical patients who require an increasing number of anaesthetics and sedation. Pharmacokinetic and pharmacodynamic changes associated with increasing age are often not appreciated enough. Dose requirements for midazolam, a benzodiazepine commonly used for outpatient procedures, have been demonstrated in prospective studies to decrease with increasing age. On the other hand, rigorous prospective studies investigating the effect of age on the induction doses of other intravenous anaesthetics, such as thiopental sodium or propofol, are missing.

In addition, many of those patients take multiple drugs for medical problems often not related to the procedure. Drug interactions with anaesthetics are likely to occur, but are not well documented.

In this review we have summarised the documented and clinically relevant drug interactions with anaesthetics in the elderly population. We have identified a significant lack of scientific and outcome data and the need for more studies and education.

Klopfenstein CE, Herrmann FR, Michel JP, et al. The influence of an aging surgical population on the anesthesia workload: a ten-year survey. Anesth Analg 1998; 86(6): 1165–70PubMed

Angus DC, Kelley MA, Schmitz RJ, et al. Caring for the critically ill patient: current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 2000 Dec 6; 284(21): 2762–70PubMed

Turnheim K. Drug dosage in the elderly: is it rational? Drugs Aging 1998; 13(5): 357–79PubMed

Dodds C. Anaesthetic drugs in the elderly. Pharmacol Ther 1995; 66(2): 369–86PubMed

Hammerlein A, Derendorf H, Lowenthal DT. Pharmacokinetic and pharmacodynamic changes in the elderly: clinical implications. Clin Pharmacokinet 1998 Jul; 35(1): 49–64PubMed

Turner N, Scarpace PJ, Lowenthal DT. Geriatric pharmacology: basic and clinical considerations. Annu Rev Pharmacol Toxicol 1992; 32: 271–302

Catterson ML, Preskorn SH, Martin RL. Pharmacodynamic and pharmacokinetic considerations in geriatric psychopharmacology. Psychiatr Clin North Am 1997; 20(1): 205–18PubMed

Feely J, Coakley D. Altered pharmacodynamics in the elderly. Clin Geriatr Med 1990 May; 6(2): 269–83PubMed

Fujita S. Aging and drug metabolism: alteration of liver drug metabolizing ability in male rats. Is it functional deterioration or feminization of the liver? Yakugaku Zasshi 1991 Nov; 111(11): 627–46PubMed

10.

Jones AG, Hunter JM. Anaesthesia in the elderly: special considerations. Drugs Aging 1996; 9(5): 319–31PubMed

11.

Klotz U. Effect of age on pharmacokinetics and pharmacodynamics in man. Int J Clin Pharmacol Ther 1998 Nov; 36(11): 581–5PubMed

12.

Ozdemir V, Fourie J, Busto U, et al. Pharmacokinetic changes in the elderly: do they contribute to drug abuse and dependence? Clin Pharmacokinet 1996; 31(5): 372–85PubMed

13.

Scott JC, Stanski DR. Decreased fentanyl and alfentanil dose requirements with age: a simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther 1987 Jan; 240(1): 159–66PubMed

14.

Lemmens HJ, Bovill JG, Hennis PJ, et al. Age has no effect on the pharmacodynamics of alfentanil. Anesth Analg 1988 Oct; 67(10): 956–60PubMed

15.

Avram MJ, Krejcie TC, Niemann CU, et al. Isoflurane alters the recirculatory pharmacokinetics of physiologic markers. Anesthesiology 2000 Jun; 92(6): 1757–68PubMed

16.

Gepts E. Pharmacokinetic concepts for TCI anaesthesia. Anaesthesia 1998 Apr; 53Suppl. 1: 4–12PubMed

17.

Henthorn TK, Krejcie TC, Niemann CU, et al. Ketamine distribution described by a recirculatory pharmacokinetic model is not stereoselective. Anesthesiology 1999 Dec; 91(6): 1733–43PubMed

18.

Hull CJ. How far can we go with compartmental models? Anesthesiology 1990 Mar; 72(3): 399–402PubMed

19.

Krejcie TC, Avram MJ. What determines anesthetic induction dose? It’s the front-end kinetics, doctor! Anesth Analg 1999 Sep; 89(3): 541–4PubMed

20.

Bailey JM. Technique for quantifying the duration of intravenous anesthetic effect. Anesthesiology 1995 Nov; 83(5): 1095–103PubMed

21.

Hughes MA, Glass PS, Jacobs JR. Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology 1992 Mar; 76(3): 334–41PubMed

22.

Schraag S, Mohl U, Hirsch M, et al. Recovery from opioid anesthesia: the clinical implication of context-sensitive half-times. Anesth Analg 1998 Jan; 86(1): 184–90PubMed

23.

Davidson MH. Does differing metabolism by cytochrome p450 have clinical importance? Curr Atheroscler Rep 2000; 2(1): 14–9PubMed

24.

Dresser GK, Spence JD, Bailey DG. Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition. Clin Pharmacokinet 2000 Jan; 38(1): 41–57PubMed

25.

Dresser GK, Bailey DG. A basic conceptual and practical overview of interactions with highly prescribed drugs. Can J Clin Pharmacol 2002 Winter; 9(4): 191–8PubMed

26.

Thummel KE, Wilkinson GR. In vitro and in vivo drug interactions involving human CYP3A. Annu Rev Pharmacol Toxicol 1998; 38: 389–430PubMed

27.

Hemeryck A, Belpaire FM. Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions: an update. Curr Drug Metab 2002; 3(1): 13–37PubMed

28.

Miners JO. Evolution of drug metabolism: hitchhiking the technology bandwagon. Clin Exp Pharmacol Physiol 2001; 29(11): 1040–4

29.

Rendic S. Summary of information on human CYP enzymes: human P450 metabolism data. Drug Metab Rev 2002; 34: 83–448PubMed

30.

Tanaka E. Clinically important pharmacokinetic drug-drug interactions of cytochrome P450 enzymes. J Clin Pharm Ther 1998; 23(6): 403–16PubMed

31.

Williams D, Feely J. Pharmacokinetic-pharmacodynamic drug interactions with CoA reductase inhibitors. Clin Pharmacokinet 2002; 41(5): 343–70PubMed

32.

Paspatis GA, Manolaraki M, Xirouchakis G, et al. Synergistic sedation with midazolam and propofol versus midazolam and pethidine in colonoscopies: a prospective, randomized study. Am J Gastroenterol 2002 Aug; 97(8): 1963–7PubMed

33.

Reimann FM, Samson U, Derad I, et al. Synergistic sedation with low-dose midazolam and propofol for colonoscopies. Endoscopy 2000 Mar; 32(3): 239–44PubMed

34.

Nieuwenhuijs DJ, Olofsen E, Romberg RR, et al. Response surface modeling of remifentanil-propofol interaction on cardiorespiratory control and bispectral index. Anesthesiology 2003 Feb; 98(2): 312–22PubMed

35.

Reves JG, Glass PSA, Lubarsky DA. Nonbarbiturate intravenous anesthetics. In: Miller RD, editor. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone, 2000: 228–72

36.

van Hemelrijck J, White PF. Nonopioid intravenous anesthesia. In: Barash PG, Cullen BF, Stoelting RK, editors. Clinical anesthesia. 3rd ed. Philadelphia: Lippincott-Raven Publishers, 1996: 311–27

37.

Fragen RJ. Infusions of intravenous anesthetics. In: Fragen RJ, editor. Drug infusions in anesthesiology. 2nd ed. Philadelphia: Lippincott-Raven Publishers, 1996

38.

McCollum JS, Dundee JW. Comparison of induction characteristics of four intravenous anaesthetic agents. Anaesthesia 1986 Oct; 41(10): 995–1000PubMed

39.

Hudson RJ, Stanski DR, Burch PG. Pharmacokinetics of methohexital and thiopental in surgical patients. Anesthesiology 1983 Sep; 59(3): 215–9PubMed

40.

Avram MJ, Sanghvi R, Henthorn TK, et al. Determinants of thiopental induction dose requirements. Anesth Analg 1993 Jan; 76(1): 10–7PubMed

41.

Bischoff KB, Dedrick RL. Thiopental pharmacokinetics. J Pharm Sci 1968 Aug; 57(8): 1346–51PubMed

42.

White PF. Clinical pharmacology of intravenous induction drugs. Int Anesthesiol Clin 1988 Summer; 26(2): 98–104PubMed

43.

Olsen RW. Barbiturates. Int Anesthesiol Clin 1988 Winter; 26(4): 254–61PubMed

44.

Krintel JJ, Wegmann F. Aminophylline reduces the depth and duration of sedation with barbiturates. Acta Anaesthesiol Scand 1987 May; 31(4): 352–4PubMed

45.

Stibolt O, Wachowiak-Andersen G. Altered response to intravenous thiopental and succinylcholine in acute amphetamine abuse. Acta Anaesthesiol Scand 2002 May; 46(5): 609–10PubMed

46.

Kaukinen S, Eerola M, Ylitalo P. Prolongation of thiopentone anaesthesia by probenecid. Br J Anaesth 1980 Jun; 52(6): 603–7PubMed

47.

Wilder-Smith OH, Ravussin PA, Decosterd LA, et al. Midazolam premedication and thiopental induction of anaesthesia: interactions at multiple end-points. Br J Anaesth 1999 Oct; 83(4): 590–5PubMed

48.

Lim TA, Inbasegaran K. Midazolam premedication and thiopental induction of anaesthesia. Br J Anaesth 2000 Jul; 85(1): 175–6PubMed

49.

Homer TD, Stanski DR. The effect of increasing age on thiopental disposition and anesthetic requirement. Anesthesiology 1985 Jun; 62(6): 714–24PubMed

50.

Stanski DR, Maitre PO. Population pharmacokinetics and pharmacodynamics of thiopental: the effect of age revisited. Anesthesiology 1990 Mar; 72(3): 412–22PubMed

51.

Davis AW, Heavner JE. Polypharmacy, age, and scheduled surgery. J Clin Anesth 2002 Aug; 14(5): 329–34PubMed

52.

Sear JW, Higham H. Issues in the perioperative management of the elderly patient with cardiovascular disease. Drugs Aging 2002; 19(6): 429–51PubMed

53.

Cillo JE, Jr. Propofol anesthesia for outpatient oral and maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87(5): 530–8PubMed

54.

Vargo JJ, Zuccaro Jr G, Dumot JA, et al. Gastroenterologistadministered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology 2002 Jul; 123(1): 8–16PubMed

55.

Wehrmann T, Kokabpick S, Lembcke B, et al. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointest Endosc 1999 Jun; 49(6): 677–83PubMed

56.

Miller LJ, Wiles-Pfeifler R. Propofol for the long-term sedation of a critically ill patient. Am J Crit Care 1998 Jan; 7(1): 73–6PubMed

57.

Marinella MA. Propofol for sedation in the intensive care unit: essentials for the clinician. Respir Med 1997 Oct; 91(9): 505–10PubMed

58.

Deegan RJ. Propofol: a review of the pharmacology and applications of an intravenous anesthetic agent. Am J Med Sci 1992 Jul; 304(1): 45–9PubMed

59.

Dundee JW, Clarke RS. Propofol. Eur J Anaesthesiol 1989 Jan; 6(1): 5–22PubMed

60.

Kanto JH. Propofol, the newest induction agent of anesthesia. Int J Clin Pharmacol Ther Toxicol 1988 Jan; 26(1): 41–57PubMed

61.

Skues MA, Prys-Roberts C. The pharmacology of propofol. J Clin Anesth 1989; 1(5): 387–400PubMed

62.

Trapani G, Altomare C, Liso G, et al. Propofol in anesthesia: mechanism of action, structure-activity relationships, and drug delivery. Curr Med Chem 2000 Feb; 7(2): 249–71PubMed

63.

Shafer SL. Advances in propofol pharmacokinetics and pharmacodynamics. J Clin Anesth 1993 Nov–Dec; 5 (6 Suppl. 1): 14S–21SPubMed

64.

Langley MS, Heel RC. Propofol: a review of its pharmacodynamic and pharmacokinetic properties and use as an intravenous anaesthetic. Drugs 1988 Apr; 35(4): 334–72PubMed

65.

Kirkpatrick T, Cockshott ID, Douglas EJ, et al. Pharmacokinetics of propofol (diprivan) in elderly patients. Br J Anaesth 1988 Feb; 60(2): 146–50PubMed

66.

Shafer A, Doze VA, Shafer SL, et al. Pharmacokinetics and pharmacodynamics of propofol infusions during general anesthesia. Anesthesiology 1988 Sep; 69(3): 348–56PubMed

67.

Schnider TW, Minto CF, Shafer SL, et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999 Jun; 90(6): 1502–16PubMed

68.

Carrasco G, Cabre L, Sobrepere G, et al. Synergistic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting. Crit Care Med 1998 May; 26(5): 844–51PubMed

69.

Cressey DM, Claydon P, Bhaskaran NC, et al. Effect of midazolam pretreatment on induction dose requirements of propofol in combination with fentanyl in younger and older adults. Anaesthesia 2001 Feb; 56(2): 108–13PubMed

70.

Keita H, Peytavin G, Giraud O, et al. Aging prolongs recovery of psychomotor functions at emergence from propofol-alfentanil anaesthesia. Can J Anaesth 1998 Dec; 45(12): 1211–4PubMed

71.

Ropcke H, Konen-Bergmann M, Cuhls M, et al. Propofol and remifentanil pharmacodynamic interaction during orthopedic surgical procedures as measured by effects on bispectral index. J Clin Anesth 2001 May; 13(3): 198–207PubMed

72.

Seifert H, Schmitt TH, Gultekin T, et al. Sedation with propofol plus midazolam versus propofol alone for interventional endoscopic procedures: a prospective, randomized study. Aliment Pharmacol Ther 2000 Sep; 14(9): 1207–14PubMed

73.

Taylor E, Ghouri AF, White PF. Midazolam in combination with propofol for sedation during local anesthesia. J Clin Anesth 1992 May–Jun; 4(3): 213–6PubMed

74.

Walder B, Borgeat A, Suter PM, et al. Propofol and midazolam versus propofol alone for sedation following coronary artery bypass grafting: a randomized, placebo-controlled trial. Anaesth Intensive Care 2002 Apr; 30(2): 171–8PubMed

75.

Giese JL, Stanley TH. Etomidate: a new intravenous anesthetic induction agent. Pharmacotherapy 1983 Sep–Oct; 3(5): 251–8PubMed

76.

Preziosi P, Vacca M. Adrenocortical suppression and other endocrine effects of etomidate. Life Sci 1988; 42(5): 477–89PubMed

77.

Arden JR, Holley FO, Stanski DR. Increased sensitivity to etomidate in the elderly: initial distribution versus altered brain response. Anesthesiology 1986 Jul; 65(1): 19–27PubMed

78.

Irifune M, Shimizu T, Nomoto M, et al. Ketamine-induced anesthesia involves the N-methyl-D-aspartate receptor-channel complex in mice. Brain Res 1992 Nov 20; 596(1–2): 1–9PubMed

79.

Klepstad P, Maurset A, Moberg ER, et al. Evidence of a role for NMDA receptors in pain perception. Eur J Pharmacol 1990 Oct 23; 187(3): 513–8PubMed

80.

Oye I. Ketamine analgesia, NMDA receptors and the gates of perception. Acta Anaesthesiol Scand 1998 Aug; 42(7): 747–9PubMed

81.

Chang T, Glazko AJ. Biotransformation and disposition of ketamine. Int Anesthesiol Clin 1974 Summer; 12(2): 157–77PubMed

82.

White PF, Johnston RR, Pudwill CR. Interaction of ketamine and halothane in rats. Anesthesiology 1975 Feb; 42(2): 179–86PubMed

83.

Clements JA, Nimmo WS. Pharmacokinetics and analgesic effect of ketamine in man. Br J Anaesth 1981 Jan; 53(1): 27–30PubMed

84.

Grant IS, Nimmo WS, Clements JA. Pharmacokinetics and analgesic effects of i.m. and oral ketamine. Br J Anaesth 1981 Aug; 53(8): 805–10PubMed

85.

White PF, Way WL, Trevor AJ. Ketamine: its pharmacology and therapeutic uses. Anesthesiology 1982 Feb; 56(2): 119–36PubMed

86.

Soliman MG, Brindle GF, Kuster G. Response to hypercapnia under ketamine anaesthesia. Can Anaesth Soc J 1975 Jul; 22(4): 486–94PubMed

87.

Dundee JW, Bovill JG, Clarke RS, et al. Problems with ketamine in adults [abstract]. Anaesthesia 1971 Jan; 26(1): 86PubMed

88.

Garfield JM, Garfield FB, Stone JG, et al. A comparison of psychologic responses to ketamine and thiopental: nitrous oxide: halothane anesthesia. Anesthesiology 1972 Apr; 36(4): 329–38PubMed

89.

Kawaguchi M, Sakamoto T, Inoue S, et al. Low dose propofol as a supplement to ketamine-based anesthesia during intraoperative monitoring of motor-evoked potentials. Spine 2000 Apr 15; 25(8): 974–9PubMed

90.

Bell RF. Low-dose subcutaneous ketamine infusion and morphine tolerance. Pain 1999; 83(1): 101–3PubMed

91.

Eilers H, Philip LA, Bickler PE, et al. The reversal of fentanyl-induced tolerance by administration of “small-dose” ketamine. Anesth Analg 2001 Jul; 93(1): 213–4PubMed

92.

Greenblatt DJ. Pharmacology of benzodiazepine hypnotics. J Clin Psychiatry 1992 Jun; 53 Suppl.: 7–13PubMed

93.

Paterniti S, Dufouil C, Alperovitch A. Long-term benzodiazepine use and cognitive decline in the elderly: the Epidemiology of Vascular Aging Study. J Clin Psychopharmacol 2002 Jun; 22(3): 285–93PubMed

94.

Bell GD, Spickett GP, Reeve PA, et al. Intravenous midazolam for upper gastrointestinal endoscopy: a study of 800 consecutive cases relating dose to age and sex of patient. Br J Clin Pharmacol 1987; 23(2): 241–3PubMed

95.

Gray SL, Lai KV, Larson EB. Drug-induced cognition disorders in the elderly: incidence, prevention and management. Drug Saf 1999; 21(2): 101–22PubMed

96.

Closser MH. Benzodiazepines and the elderly: a review of potential problems. J Subst Abuse Treat 1991; 8(1–2): 35–41PubMed

97.

Greenblatt DJ. Benzodiazepine hypnotics: sorting the pharmacokinetic facts. J Clin Psychiatry 1991 Sep; 52 Suppl.: 4–10PubMed

98.

Greenblatt DJ, Harmatz JS, Shader RI. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly: therapeutic considerations (Part I). Clin Pharmacokinet 1991 Sep; 21(3): 165–77PubMed

99.

Lechin F, van der Dijs B, Benaim M. Benzodiazepines: tolerability in elderly patients. Psychother Psychosom 1996; 65(4): 171–82PubMed

100.

Reves JG, Fragen RJ, Vinik HR, et al. Midazolam: pharmacology and uses. Anesthesiology 1985 Mar; 62(3): 310–24PubMed

101.

Shorr RI, Robin DW. Rational use of benzodiazepines in the elderly. Drugs Aging 1994 Jan; 4(1): 9–20PubMed

102.

Amrein R, Hetzel W. Pharmacology of Dormicum (midazolam) and Anexate (flumazenil). Acta Anaesthesiol Scand Suppl 1990; 92: 6–15PubMed

103.

Mohler H, Richards JG. The benzodiazepine receptor: a pharmacological control element of brain function. Eur J Anaesthesiol Suppl 1988; 2: 15–24PubMed

104.

Mohler H, Fritschy JM, Rudolph U. A new benzodiazepine pharmacology. Eur J Anaesthesiol Suppl 2002 Jan; 300(1): 2–8

105.

Forster A, Gardaz JP, Suter PM, et al. Respiratory depression by midazolam and diazepam. Anesthesiology 1980 Dec; 53(6): 494–7PubMed

106.

Alexander CM, Gross JB. Sedative doses of midazolam depress hypoxic ventilatory responses in humans. Anesth Analg 1988 Apr; 67(4): 377–82PubMed

107.

Alexander CM, Teller LE, Gross JB. Slow injection does not prevent midazolam-induced ventilatory depression. Anesth Analg 1992 Feb; 74(2): 260–4PubMed

108.

Bailey PL, Pace NL, Ashburn MA, et al. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990 Nov; 73(5): 826–30PubMed

109.

Olkkola KT, Aranko K, Luurila H, et al. A potentially hazardous interaction between erythromycin and midazolam. Clin Pharmacol Ther 1993 Mar; 53(3): 298–305PubMed

110.

Palkama VJ, Isohanni MH, Neuvonen PJ, et al. The effect of intravenous and oral fluconazole on the pharmacokinetics and pharmacodynamics of intravenous alfentanil. Anesth Analg 1998; 87(1): 190–4PubMed

111.

Palkama VJ, Ahonen J, Neuvonen PJ, et al. Effect of saquinavir on the pharmacokinetics and pharmacodynamics of oral and intravenous midazolam. Clin Pharmacol Ther 1999 Jul; 66(1): 33–9PubMed

Titel: Clinically Important Drug Interactions with Intravenous Anaesthetics in Older Patients
verfasst von: Dr Helge Eilers
Claus U. Niemann
Publikationsdatum: 01.11.2003
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 13/2003
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.2165/00002512-200320130-00002

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