Influence of haemorrhage on the pseudo-steady-state remifentanil concentration in a swine model: a comparison with propofol and the effect of haemorrhagic shock stage
Influence of haemorrhage on the pseudo-steady-state remifentanil concentration in a swine model: a comparison with propofol and the effect of haemorrhagic shock stage
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DOI：
10.1093/bja/aer233
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发表时间：
2011-11-01
影响因子：
9.8
通讯作者：
Sato, S.
中科院分区：
文献类型：
--
作者：
Kurita, T.;Uraoka, M.;Sato, S.
背景资料。失血性休克时瑞芬太尼浓度升高以及这一效应与异丙酚的差异尚不完全清楚。我们在猪模型上观察了出血对瑞芬太尼拟稳态血药浓度的影响，并与异丙酚的变化进行了比较。以瑞芬太尼0.5 mg kg~(-1)min~(-1)和异丙酚6 mg kg~(-1)h~(-1)静脉滴注60min后，9头猪[平均(标准差)体重26.3(1.3)kg]采用阶段性失血模型(每30min抽血10%至1.5h，以后每30min逐级抽血5%，直至循环衰竭)。测定每一步的血流动力学和代谢指标以及瑞芬太尼和异丙酚的血浆浓度。在达到循环衰竭之前，平均放血913(82)毫升。失血前血药浓度的增加符合下列方程：瑞芬太尼增加%=2.1x累计失血量(占初始血容量的百分比)，丙泊酚增加%=0.7x失血性休克代偿期，瑞芬太尼增加%=27.4x累计失血量-897，丙泊酚增加%=9.5x累计失血量-306。瑞芬太尼浓度与心输出量的倒数高度相关。出血时持续输注瑞芬太尼的血药浓度较丙泊酚升高3倍以上。
Background. The increase in remifentanil concentration during haemorrhagic shock and the difference between this effect and that for propofol are not fully understood. We investigated the influence of haemorrhage on the pseudo-steady-state remifentanil concentration in a porcine model and compared the changes with those for propofol.Methods. After infusion of remifentanil (0.5 mg kg(-1) min(-1)) and propofol (6 mg kg(-1) h(-1) after 2 mg kg(-1) bolus infusion) for 60 min, nine swine [mean (standard deviation) body weight 26.3 (1.3) kg] were studied using a stepwise haemorrhage model (10% of estimated blood volume removed every 30 min until 1.5 h, and stepwise removal of 5% every 30 min thereafter until circulatory collapse). Haemodynamic and metabolic variables and plasma remifentanil and propofol concentrations were measured at every step.Results. A mean volume of 913 (82) ml of blood was drained before reaching circulatory collapse. The increases in plasma concentrations from the prehaemorrhagic value fitted the following equations:% increase in remifentanil=2.1xcumulative blood loss (% of initial blood volume) and% increase in propofol=0.7xcumulative blood loss during compensated shock; and% increase in remifentanil=27.4xcumulative blood loss-897 and% increase in propofol=9.5xcumulative blood loss-306 during uncompensated shock. Remifentanil concentrations were highly correlated with the reciprocal of cardiac output.Conclusions. During haemorrhage, the plasma remifentanil concentration showed a threefold greater increase than that of propofol in administration by continuous infusion.