| The pharmacokinetics of anesthetic drugs and adjuvants during cardiopulmonary bypass. | |
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MedLine Citation:
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PMID: 10714838 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The institution of cardiopulmonary bypass during cardiac surgery has profound effects on the plasma concentration of drugs and thus their therapeutic effectiveness. These changes occur through acute hemodilution, altered plasma protein binding, hypotension, as well as the use of hypothermia and heparin administration. Isolation of the lungs from the circulation and the possible sequestration of drugs in the bypass circuit also affect drug plasma concentrations on bypass. The individual characteristics of the drug in question are also important in determining the final plasma concentration: Lipid soluble drugs with a high volume of distribution may be more readily taken up by bypass equipment, but the initial fall in concentration at the start of cardiopulmonary bypass may be more readily counteracted by back diffusion into plasma, if large tissue stores have accumulated. The extent of the drug's plasma protein binding is of importance as the effective free fraction in plasma for highly bound drugs will be sensitive to changes in plasma protein binding brought on by factors such as hemodilution, heparin administration as well as alpha, acid-glycoprotein binding. Clearly the fate of drugs administered before or on bypass is complex and can only be accurately determined by specific studies evaluating drug plasma concentrations. This review updates the available data on anesthetics and drugs used during cardiac surgery in order that anesthetists may predict better the likely effect of drugs administered before or during cardiopulmonary bypass. |
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Authors:
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B Mets |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Acta anaesthesiologica Scandinavica Volume: 44 ISSN: 0001-5172 ISO Abbreviation: Acta Anaesthesiol Scand Publication Date: 2000 Mar |
Date Detail:
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Created Date: 2000-03-23 Completed Date: 2000-03-23 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 0370270 Medline TA: Acta Anaesthesiol Scand Country: DENMARK |
Other Details:
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Languages: eng Pagination: 261-73 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York 10032, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Analgesics, Opioid
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pharmacokinetics Anesthetics / pharmacokinetics* Anti-Bacterial Agents / pharmacokinetics Blood Proteins / metabolism Cardiopulmonary Bypass* Cardiovascular Agents / pharmacokinetics Hemodilution Humans Muscle Relaxants, Central / pharmacokinetics Protein Binding |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Anesthetics; 0/Anti-Bacterial Agents; 0/Blood Proteins; 0/Cardiovascular Agents; 0/Muscle Relaxants, Central |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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