Drug interactions: volatile anesthetics and opioids.

Journal Article (Journal Article;Review)

Multiple drugs are used to provide anesthesia. Volatile anesthetics are commonly combined with opioids. Several studies have demonstrated that small doses of opioid (i.e., within the analgesic range) result in a marked reduction in minimum alveolar concentration (MAC) of the volatile anesthetic that will prevent purposeful movement in 50% of patients at skin incision). Further increases in opioid dose provide only a further small reduction in MAC. Thus, a ceiling effect of the opioid is observed at a MAC value of the volatile anesthetic equal to its MAC awake. Recovery from anesthesia when an opioid is combined with a volatile anesthetic is dependent on the rate of decrease of both drugs to their respective concentrations that are associated with adequate spontaneous ventilation and awakening. Through an understanding of the pharmacodynamic interaction of volatile anesthetics with opioids and the pharmacokinetic processes responsible for the recovery from drug effect, optimal dosing schemes can thus be developed. A review of these pharmacodynamic and pharmacokinetic principles that will allow clinicians to administer drugs to provide a more optimal anesthetic is provided.

Full Text

Duke Authors

Cited Authors

  • Glass, PS; Gan, TJ; Howell, S; Ginsberg, B

Published Date

  • September 1997

Published In

Volume / Issue

  • 9 / 6 Suppl

Start / End Page

  • 18S - 22S

PubMed ID

  • 9278850

International Standard Serial Number (ISSN)

  • 0952-8180

Digital Object Identifier (DOI)

  • 10.1016/s0952-8180(97)00122-0


  • eng

Conference Location

  • United States