How to approach toxicity of medications in anaesthesia

Dec 26, 2021

The discussion highlights the complexities of medication toxicity in anaesthesia. A three-part framework explores drug choice, exposure over time, and patient-specific variables that can elevate risks. They dissect specific agents like lignocaine and cocaine, revealing their unique toxicities. Factors such as dosing frequency and patient health—ranging from neonates to the elderly—are also scrutinized. Listeners gain insights into how to apply this framework to various drug classes, enhancing their understanding of pharmacology in practice.

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ANECDOTE

Outsourcing To Recover Balance

Lahiru describes outsourcing video and website editing to regain work–life balance after lockdown burnout.
He emphasizes focusing on strengths (teaching anaesthesia) and delegating tedious tasks.

INSIGHT

Map Framework To Pharmacology

Drug choice maps to pharmaceutics, exposure across time maps to pharmacokinetics, and patient variables map to pharmacodynamics.
Framing toxicity as a flow (choice → exposure → patient) helps link concepts and clinical relevance.

ADVICE

List Drugs Then Link Toxicities

When listing topical local anesthetics, name both amides and esters (e.g., lignocaine, prilocaine, cocaine, amethocaine, oxybuprocaine).
Then link each drug to its specific toxicities rather than only giving generic effects.

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Drug Choice

⁃Describe toxicities that are specific to:

⁃1) Drug Class

⁃2) Individual Drug

Drug Exposure Across Time (Dt)

⁃Factors that increase (Dt) will increase the risk of toxicity. These will include:

⁃1) Increased or Additive Dosing from the same class of drugs

⁃2) Duration and Frequency of Exposure

⁃3) Decreased Hepatic Clearance

⁃4) Decreased Renal Elimination

Patient Variabilities

⁃For drugs that require hepatic metabolism

⁃1) Neonates and patients with hepatic failure have decreased hepatic enzyme activity

⁃2) Elderly and patients with cardiac failure have decreased cardiac output and decreased hepatic blood flow

⁃For drugs that require renal elimination

⁃1) Neonates and patients with renal failure have decrease renal blood flow

⁃Pathological and Genetic factors may increase toxicity

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