Influence of cardiac output on the pseudo-steady state remifentanil and propofol concentrations in swine
Influence of cardiac output on the pseudo-steady state remifentanil and propofol concentrations in swine
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DOI：
10.1111/aas.12076
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发表时间：
2013-07-01
影响因子：
2.1
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：丙泊酚在恒定输注过程中的浓度受心输出量变化的影响，但这种变化对瑞芬太尼的影响尚不清楚，瑞芬太尼经常与丙泊酚联合使用。方法10只猪吸入异氟醚麻醉，并以1.5%异氟醚维持麻醉。在输注瑞芬太尼（0.5g/kg/min）和丙泊酚（2 mg/kg推注后6 mg/kg/h）60 min（基线1）后，通过持续输注多巴酚丁胺和终止异氟烷（高心输出量状态）增加心输出量。然后停止多巴酚丁胺输注，重新开始1.5%异氟烷输注，允许心输出量恢复至基线（基线2）。最后，通过给予3%异氟烷降低心输出量（低心输出量状态）。在改变为每种血流动力学状态后10、30和60 min从股动脉采集血样。结果瑞芬太尼和丙泊酚血药浓度与心输出量呈负相关。血浆药物浓度由以下公式给出：[瑞芬太尼]（ng/ml）=17.5/心输出量（l/min）+4.52;[丙泊酚]（g/ml）=3.34/心输出量+1.17。心输出量的变化对瑞芬太尼的影响与丙泊酚相似，随着心输出量的减少，对每种药物浓度的影响更大。结论瑞芬太尼和丙泊酚麻醉时，心输出量对瑞芬太尼血药浓度的影响与丙泊酚相似，只是代谢部位不同。
Background The propofol concentration during constant infusion is affected by a change in cardiac output, but the effect of this change on remifentanil, which is frequently used in combination with propofol, is unclear. Methods Ten swine were anaesthetised through inhalation of isoflurane and maintained with 1.5% isoflurane. After infusion of remifentanil (0.5g/kg/min) and propofol (6mg/kg/h after 2mg/kg bolus infusion) for 60min (baseline 1), cardiac output was increased by continuous infusion of dobutamine and termination of isoflurane (high cardiac output state). Dobutamine infusion was then stopped, 1.5% isoflurane was restarted, and cardiac output was allowed to return to baseline (baseline 2). Finally, cardiac output was decreased by administration of 3% isoflurane (low cardiac output state). Blood samples were collected from the femoral artery at 10, 30, and 60min after the change to each haemodynamic state. Results An inverse relationship was found between cardiac output and the plasma remifentanil and propofol concentrations. The plasma drug concentrations were given by the following equations: [remifentanil] (ng/ml)=17.5/cardiac output (l/min)+4.52; and [propofol] (g/ml)=3.34/cardiac output+1.17. The influence of changes in cardiac output on remifentanil were similar to those for coadministered propofol and the influence on the concentration of each drug was greater with decreasing cardiac output. Conclusions The plasma remifentanil concentration is influenced by cardiac output in a similar manner to that of propofol during remifentanil and propofol anaesthesia, although the metabolic sites are different.