Peridural Anesthesia and the Distribution of Blood in Supine Humans

Arndt, J. O.; Höck, A.; Stanton‐Hicks, Michael; Stühmeier, K. L.

doi:10.1097/00132582-198606000-00007

Cited by 20 publications

(20 citation statements)

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“…21 The vasodilated legs have a relatively slow time constant for venous return 22 and, from a kinetic point of view, probably become part of the secondary fluid space (v2). Thus, our findings are consistent with that transient differences in haemodilution develop between different major venous vessels in the body when spinal anaesthesia has just been induced.…”

Section: Discussionmentioning

confidence: 99%

Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Hahn

Resby

1998

Can J Anaesth

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Purpose: To study how the body handles fluid given intravenously during the onset of spinal anaesthesia in women scheduled for Caesarean section. Methods: The effect of spinal anaesthesia on the volume kinetics of a constant-rate infusion of 25 ml.kg -l of Ringer's solution (n = I I) and I 0 ml'kg -I of dextran 3% 60 (n = 8) was studied before elective Caesarean section. Measurements of the blood haemoglobin concentration and urine excretion served as input variables in calculations of the size(s) of the body fluid spaces expanded by the infused fluid. The blood glucose level was also monitored, Results: When a one-volume kinetic model were fitted to the data, spinal anaesthesia reduced the size of the expanded body fluid space by 30% (Ringer's) and 58% (dextran) (P < 0.02) When a two-volume model was statistically justified, anaesthesia reduced the rate of fluid equilibration between the two expanded body fluid spaces by 47% and 19%, respectively (P < 0.04) The baseline volume for the primary (central) fluid space was smaller than the expected plasma volume; 1.5 I for Ringer's solution and 0.9 1 for dextran. Only small changes in the blood glucose concentration were found. Conclusion: The onset of spinal anaesthesia induces acute changes in the body's handling of infused fluid that can be described by volume kinetic analysis.Objectis : l~tudier le devenir des liquides administrEs par voie intraveineuse durant l'induction de l'anesth&ie rachidienne chez des parturientes subissant une cEsarienne. M&hodes : Les effets de la rachianesthEsie sur la cinEtique volum&rique d'une infusion ~ debit constant de 25 ml'kg -t de solution de Ringer (n= I I) ou de I0 ml.kg -I de dextran 60 en solution ~ 3% (n=8) ont &E EtudiEs avant la c&arienne Elective. Les mesures du taux d'hEmoglobine sanguin et du debit urinaire ont servi comme entrees variables dans le calcul de l'expansion volEmique par le liquide infuse des diffErents compartiments corporels. La glycEmie a aussi EtE mesurEe, l~sultats : Lorsque les donnEes &aient rapportEes ~ un modEle cin&ique ~ un seul compartiment, l'anesthEsie rachidienne entra?nait une reduction du compartiment corporel dEj~ distendu de 30% pour le Ringer et de 58% pour le dextran (P 0,02). Lorsqu'un modEle ~ deux compartiments apparaissait justifiE d'un point de vue statistique, l'anesth&ie entra~nait une reduction du taux d'Equilibration entre les deux compartiments corporels dEj~ distendus de 47% et de 1996 respectivement (P 0,04). Le volume de base pour le compartiment primaire (central) &ait plus petit que le volume plasmatique prEvu: 1,5L pour le Ringer et 0,9L pour le dextran. La glycEmie a peu variE. Conclusion : l'induction de l'anesthEsie rachidienne entra?ne des modification aigu~s de la gestion par le corps humain des liquides infuses, ces modifications pouvant &re d&rites par des analyses de cinEtique volumEtrique.

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Section: Discussionmentioning

confidence: 99%

Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Hahn

Resby

1998

Can J Anaesth

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“…Spinal and epi(peri)dural anaesthesia also reduce CBV, 44,45 although the reduction of CBV then results from redistribution of blood as a complication to surgical analgesia and/or postoperative pain treatment. Because the responses to haemorrhage and sitting or standing up are comparable, there is no fundamental distinction between the physiology and pathophysiology of a reduced CBV.…”

Section: Clinical and Experimental Hypovolaemic Shockmentioning

confidence: 99%

Normovolaemia defined by central blood volume and venous oxygen saturation

Secher

Lieshout

2005

Clin Exp Pharma Physio

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“…This may be explained by the age-related decrease in cardiac output and associated decrease in hepatic blood flow in elderly patients (27,28). Hepatic blood flow may also be decreased during epidural anesthesia despite maintenance of normotension (8), or by blockade of the splanchnic sympathetic nerves, i.e., epidural blockade that reaches T 5 thoracic dermatome reduces splanchnic perfusion (29). Therefore, infusion of lidocaine during continuous epidural anesthesia may result in high serum lidocaine concentrations, especially in elderly patients.…”

Section: Comparing Results Of Othersmentioning

confidence: 99%

A Population Pharmacokinetic Model of Epidural Lidocaine in Geriatric Patients: Effects of Low-Dose Dopamine

Kwa¹,

Šprung²,

Guilder³

et al. 2008

Therapeutic Drug Monitoring

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Purpose-To develop a population pharmacokinetic (PK) model of epidural lidocaine in geriatric patients, to search for any difference in the PK behavior of epidural lidocaine when dopamine is given concurrently, and to develop a descriptive PK model from which to calculate dosage and infusion regimens of epidural lidocaine to define and achieve desired target goals in either the epidural or the serum compartment. Methods-Twenty patients over age 65, undergoing peripheral vascular surgery using continuous epidural lidocaine anesthesia, were studied. Ten patients also received an intravenous (IV) infusion of placebo (normal saline), while ten other patients received an IV infusion of dopamine at 2 μg/kg/ min. Total plasma lidocaine concentrations (gas-chromatographic assay) were measured from arterial samples just before injecting the first epidural dose (baseline) and then at 5, 15, 30, 60, 90, 120 min and hourly thereafter. Samples were also taken when the lidocaine infusion was stopped at the end of the surgery, and at 30min, 60min, 90min, 2h, 3h, 4h, and 5h after surgery. The nonparametric adaptive grid (BigNPAG) computer program in the MM-USCPACK collection was utilized for population PK modeling to obtain the entire discrete maximum likelihood joint parameter distribution. The assay error polynomial was determined to be 0.2 + 0.05*C. The structural population PK model was linear, and had 3 compartments, each with first order transfer kinetics.Results-Lidocaine had a very fast transfer rate constant (Ka part + K20) from the epidural space to the serum compartment. This rate was slowed, by over 41%, by dopamine. The mean rate constant of elimination from the serum compartment (K20) was increased by 9.7 % by dopamine. The mean rate constant for drug movement from central to peripheral compartment (K23) was increased by 47% in the dopamine patients. The mean rate constant back from the peripheral to the central compartment (K32) was slowed by 46% by dopamine. There was no obvious difference in the apparent volume of distribution of the central compartment between the placebo and the dopamine patients. In this model, there was no specific compartment for Lidocaine in the cerebrospinal fluid (CSF). CSF is probably one of the components of the overall peripheral, nonserum, compartment in our model. Conclusions-In this first population model of epidural lidocaine using a statistically consistent method, low-dose dopamine appears to decrease the rate of transfer of lidocaine from the epidural to the serum compartment, and to increase both the rate of elimination of lidocaine as well as its transfer between the central (serum) and peripheral compartment, presumably by increasing tissue perfusion. Serum lidocaine concentrations were slightly less in the dopamine patients. Dosage requirements (overall hourly weight-adjusted infusion rates) were slightly less for the dopamine patients, consistent with the slower removal of lidocaine from the epidural compartment. This model should be useful to design more optimal ...

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Peridural Anesthesia and the Distribution of Blood in Supine Humans

Cited by 20 publications

References 0 publications

Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Normovolaemia defined by central blood volume and venous oxygen saturation

A Population Pharmacokinetic Model of Epidural Lidocaine in Geriatric Patients: Effects of Low-Dose Dopamine

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