Expert: Ronald Levy, M.D. - 1/4/2011

Question
Dear Dr. Levy,

Thank you for your time!  This is purely a curiosity question from a neurobiology major, but I understand completely if it is too controversial to answer.

Antagonistic agents are interesting to me. In theory, if a person were given a very powerful depressant (sevoflurane or propofol, for example) while simultaneously receiving a very powerful stimulant (methamphetamine or cocaine, etc), which would "win out", the stimulant or depressant? (By win out, would the person fall asleep or be awake?). That of course assumes the impossible, that safety could be maintained.

Since it is dose-dependent, I suppose I am curious about the result as both agents are increased simultaneously and continuously (which would plateu first)?   

Thank you very much.  It is purely academic!

                  -Ben

Answer
Without any evidence to back this up other than experience, I would say that the depressant will win out and the patient will go to sleep. The stimulants will certainly affect the blood pressure, HR, etc but since they are working on different areas of the brain, they will each have the appropriate effects. As for plateauing, I would think that the stimulants would likely pateau first (based on their mechanism of action) but again I have no hard data (and no one ever will) to back this up.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston