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REGIONAL ANESTHESIA

Unrecognized Drug-Drug Interactions: A Cause of Intraoperative Cardiac Arrest?

Catherine Marcucci, MD^*, Neil B. Sandson, MD, Eric M. Thorn, MD, and Denis L. Bourke, MD^*

*Department of Anesthesiology, University of Maryland, Baltimore; Department of Psychiatry and Division of Cardiology, University of Maryland Medical System, Baltimore; and Sheppard and Enoch Pratt Hospital, Towson, Maryland

Address correspondence and reprint requests to Catherine Marcucci, MD, Department of Anesthesiology, University of Maryland, 1210 Maple Leaf Ct., Cockeysville, MD 21030. Address e-mail to sandson.marcucci{at}comcast.net.

Many physicians overlook, or are unaware of, most drug-drug interactions. In our patient, the local anesthetic used for an axillary block may have been the precipitating drug in a cascade of drug-drug interactions that resulted in a cardiac arrest. The combination of multiple preoperative drug-drug interactions prevented the return of a stable native cardiac rhythm for almost 24 h. The mechanisms of interactions of these frequently used drugs are described, and the reader is guided to sources that identify and simplify the understanding of potentially dangerous drug-drug interactions.

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