KINETICS OF THIOPENTAL DURING CARDIOPULMONARY BYPASS AND CORONARY REPERFUSION

心肺转流术和冠状动脉再灌注期间硫喷妥钠的动力学

• 批准号: 3939442
• 负责人: P K NARANG
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3939442
• 关键词: anesthetics; blood chemistry; dosage; drug metabolism; heart /lung bypass; heart revascularization; high performance liquid chromatography; human subject; hypothermia; liver metabolism; pharmacokinetics; thiopental

Sodium thiopental, a short acting barbiturate, is commonly employed in cardiac surgery as an anesthetic. In order to optimize dosage of this myocardial depressant in patients undergoing cardiopulmonary bypass, we have studied 20 patients and evaluated the influence of hemodilution and hypothermia during the bypass procedure. We quantitated plasma levels of thiopental in patients and kinetically calculated the fraction of drug that is being metabolized hepatically. Although the hepatic extraction and hepatocellular intrinsic clearance are significantly lowered during hypothermic state (temp: 25 degree C) the thiopental levels at the time of taking the aortic clamp off and when the patients is fully rewarmed were not higher than previously observed in non-bypass patients. This is because the decreased metabolism appears to be counter-balanced by increased free fraction due to hemodilution and may be increased partitioning into tissues, e.g., fat. This indicates that no dosage changes may be necessary for anesthetic dose.

硫喷妥钠是一种短效巴比妥酸盐，通常 在心脏外科手术中用作麻醉剂。为了 心肌抑制药在患者中的最佳用量 在体外循环手术中，我们研究了20例患者 并评价血液稀释和低温的影响。 在搭桥手术期间。我们对血浆中的 硫喷妥钠在患者体内，并动态计算其分数 通过肝脏代谢的药物。虽然肝组织 提取和肝细胞内源性清除显著 在低温状态(温度：25摄氏度)期间降低 取下主动脉夹子时硫喷妥的血药浓度 当患者完全复温时，不高于 以前在非搭桥患者中观察到。这是因为 新陈代谢的减少似乎被 由于血液稀释而增加的游离分数，可能会增加 分割成组织，例如脂肪。这表明没有剂量 改变麻醉剂量可能是必要的。