Miller Anestesia

1945 / 2894

del VIH) que se administran a los pacientes trasplantados actúan
también como sustratos, modulares o ambos del citocromo P4503A
y de la glucoproteína P. Estos medicamentos pueden presentar
interacciones con los que se usan habitualmente en el período
perioperatori .
Aunque es probable que se produzcan interacciones entre
los fármacos inmunosupresores y los anestésicos, son pocos los
estudios en los que se ha investigado de forma prospectiva y
aleatorizada el impacto de los primeros sobre los segundos. En
investigaciones efectuadas en animales se demostró que la ciclos-
porina altera las necesidades de barbitúricos, fentanilo e isoflu-
ran . Sin embargo, el significado clínicode estas interacciones
no ha sido aún estudiado. De igual forma, parece que la ciclos-
porina potencia los efectos del bloqueo neuromuscular, según se
demostró en varios estudios con animales y en casos aislados
publicado A pesar de la falta de estudios adecuados en el
ser humano, parece razonable prever una reducción de las nece-
sidades de los relajantes musculares no despolarizantes en los
pacientes que reciben ciclosporina. Por el contrario, la azatio-
prina produjo un antagonismo pequeño y transitorio frente al
bloqueo muscular no despolarizante en los pacientes con insufi-
ciencia renal, aunque se consideró inapreciable desde el punto de
vista clínico. También se observó en un estudio en animales que
la azatioprina no modificaba las necesidades de azatioprina ni
atracurio.
La complejidad del protocolo inmunosupresor junto con los
tratamientos complementarios hace que sea probable la aparición
de interacciones farmacológicas relevantes desde el punto de vista
clínico. La revisión preoperatoria detallada de la medicación de los
pacientes debe centrarse en los posibles efectos secundarios, en las
interacciones farmacológicas y en las eventuales implicaciones
para la planificación anestésic
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Anestesia en el trasplante de órganos abdominales 1945 57
Sección IV
Anestesia por subespecialidades en el adulto
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