Influence of hemorrhagic shock on the pharmacokinetics and pharmacodynamics of intravenous anesthetics

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The remifentanil concentration during continuous infusion undergoes an increase that is three times higher than that for co-administered propofol with progression of haemorrhage. This result indicates that the remifentanil dose should be reduced substantially compared with propofol for patients with significant blood loss.The remifentanil concentration during continuous infusion is affected by cardiac output, which changes easily in response to anaesthetic depth and/or administration of inotropic agents. The extent of the influence of cardiac output on the remifentanil concentration is similar to that on coadministered propofol, in contrast to the responses of these two drugs during haemorrhagic shock. The influence of decreased cardiac output on both drug concentrations is greater than that of increased cardiac output. These results indicate that the actual blood concentrations might substantially deviate from the expected concentrations in a low cardiac output state.