Pharmacokinetics and pharmacodynamics of cisatracurium in patients undergoing surgery with two hemodilution methods

Guo, Juan; Yuan, Xiaohong; Zhou, Xiaofang; Jin, Xin

doi:10.1016/j.jclinane.2017.01.013

Cited by 7 publications

(7 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hemodilution can also improve the supply to the tissue microcirculation, with a definite action of organ protection. 6,7 The hemodilution methods include acute isovolumetric hemodilution and acute hypervolemic hemodilution, the latter of which is less difficult to perform, requires less equipment and fewer human resources, and it can effectively reduce the risk of blood contamination and damage to the blood components. 6,7 Acute hypervolemic hemodilution (AHH) refers to the rapid infusion of a certain dose of colloidal fluid or crystal fluid over a period which ultimately leads to rapid dilution of blood volume and decrease of hematocrit level, and it increases the circulating blood volume by approximately 20%-25% and reduces the effective blood component concentration.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 The hemodilution methods include acute isovolumetric hemodilution and acute hypervolemic hemodilution, the latter of which is less difficult to perform, requires less equipment and fewer human resources, and it can effectively reduce the risk of blood contamination and damage to the blood components. 6,7 Acute hypervolemic hemodilution (AHH) refers to the rapid infusion of a certain dose of colloidal fluid or crystal fluid over a period which ultimately leads to rapid dilution of blood volume and decrease of hematocrit level, and it increases the circulating blood volume by approximately 20%-25% and reduces the effective blood component concentration. 8 By performing acute hypervolemic hemodilution treatment, one is assured that under the premise of the same amount of bleeding, the loss of adequate blood components can be significantly reduced, the patients will have a higher blood loss tolerance, and it helps maintain a balanced state of cerebral oxygen supply and demand At present, acute hypervolemic hemodilution is widely used in thoracic operations, spinal operations, aneurysm operations, gastrointestinal operations, liver operations, meningioma operations, urinary system operations, and the results have been proved to be satisfactory.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hypervolemic Hemodilution as a Management During Predicted Massive Bleeding Sectio Caesarea in Placenta Accreta Patient

Fanniyah

Hartono

2022

JAP

View full text Add to dashboard Cite

Background: Placenta accreta represents one of the most morbidity conditions in modern obstetrics, with high hemorrhage rates, hysterectomy, and intensive care unit admission. Alternative management during intraoperative bleeding is haemodilution. There are two techniques in hemodilution, including autonomic normovolemic hemodilution and hypervolemic hemodilution. Case: A gravida patient, physical status ASA II with a suspected placenta accreta was planned for a cesarean section. Hypervolemic hemodilution was conducted to anticipate bleeding. Hemodilution was performed with a total fluid of 2000 ml. Total bleeding during surgery is 3500 ml. Close monitoring of hemoglobin (Hb) and hematocrit (Hct) was conducted. The initial Hb and Hct were 9.9 mg/dl and 29.8%. Hb and Hct post-haemodilution 5.7 mg/dl, and 17.1%. Postoperatively, Hb and Hct become 5.4 mg/dl and 16.6%. The patient has been given 450 ml packed red cells (PRC) blood transfusion. The patient was observed in the intensive care unit for 24 hours postoperatively and was subsequently transferred to the ward. The total bleeding was 3500 ml, and there was a reduction of Hb from 5.7 to 5.4 and Hct from 17.7% to 16.6%. Conclusion: In this case, hemodilution was proven effective based on the post-hemodilution and post-hemorrhage Hb and Hct. Hemodilution may be alternative management during intraoperative hemorrhage. However, the anticipation and effect that might arise from hemodilution should be considered.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hypervolemic Hemodilution as a Management During Predicted Massive Bleeding Sectio Caesarea in Placenta Accreta Patient

Fanniyah

Hartono

2022

JAP

View full text Add to dashboard Cite

show abstract

“…This mode of administration may thus result in large uctuations in blood concentration, unstable myorelaxation, and di culty in estimation of myorelaxation recovery time [9] . The other mode of administration is continuous pumping, which can maintain a relatively constant blood concentration, easily control the myorelaxation effect and recovery time, and reduce the occurrence of myorelaxation residuals [10] . In this study, the intraoperative cisatracurium dosage was signi cantly less in the continuous pumping patients than in the intermittent dosing group, and time to recovery of muscle strength, time to return to normal respiration, and time to extubation of the tracheal tube were all signi cantly shorter in the continuous pumping group than in the intermittent dosing group, with statistically signi cant differences.…”

Section: Discussionmentioning

confidence: 99%

Observations on the Use of Different Modes of Cisatracurium Administration in Hyperthermic Intraperitoneal Chemotherapy

Zhang¹,

Gao²,

Liu³

et al. 2021

Preprint

View full text Add to dashboard Cite

Objective: To investigate the residual effects of cis-atracurium with different administrations in patients with hyperthermic intraperitoneal chemotherapy.Methods: 60 patients undergoing hyperthermic intraperitoneal chemotherapy were randomly divided into two groups with 30 cases in each group. All patients were induced with sufentanil 0.4ug/kg, propofol 2.0mg/kg and cis atracurium 0.2mg/kg. During the operation, sevoflurane and remifentanil were used to maintain anesthesia. BIS value was 45-55. The control group intermittently received cis-atracurium injection with 0.1mg/kg/h. The experimental group received continuous injection of cis-atracurium at a rate of 1.5ug/kg/min. Cis-atracurium was discontinued 30min before the end of the operation, sevoflurane inhalation was stopped 20min before the end of the surgery and remifentanil was discontinued 10min before the end. At the end of the operation, no muscle relaxant antagonism were applied. General information of patients was recorded. Mean arterial pressure (MAP), heart rate (HR), tidal volume (VT), respiratory rate (F), and blood oxygen saturation (SpO2) were recorded before anesthesia (T1) , at the time of tracheal catheter extraction (T2).Besides, the total amount of cis-atracurium, the time of recovery of spontaneous tidal volume to 6ml/kg (t1), the time of continuous lifting of the head for 5 s (t2), and the time from the withdrawal of muscle relaxant to the removal of the tracheal catheter (t3) were recorded. Blood gas analysis was also performed to record PaO2 and PaCO2 before anesthesia, when leaving the operating room and SICU. Moreover, relevant adverse reactions were recorded.Results: 1) general situation: there was no difference in body weight, operation time, ASA classification and other indicators between the two groups (P>0.05). 2) comparison of residual effects of muscle relaxants: the values of t1, t2 and t3 in the experimental group were significantly shorter than those in the control group (P<0.05). There was no significant difference between the two groups in PaO2 and PaCO2 before anaesthesia, when out of the operating room and when out of SICU (P>0.05). 3) hemodynamic comparison: there were no statistically significant differences in mean arterial pressure, heart rate, tidal volume, respiratory rate and blood oxygen saturation between the two groups at time points T1 and T2 (P>0.05). 4) comparison of adverse events: no adverse events occurred in either group.Conclusion: Compared with intermittent infusion, continuous infusion of cis-atracurium did not result in significant residual muscle relaxation and no significant histamine release. Therefore, continuous infusion is more suitable for long-term surgery.

show abstract

“…However, problems such as their impacts on coagulation function and the refractory tissue edema caused by leakage from the blood vessels still cannot be completely avoided. Altogether, isotonic solution can only passively expand blood volume, and cannot actively dredge the capillaries and improve microcirculation [ 19 ]. In contrast, hypertonic sodium chloride solution can quickly increase blood volume, correct hypoglycemia, improve organ blood flow and hemodynamics, and effectively increase myocardial contractility.…”

Section: Discussionmentioning

confidence: 99%

Acute Hypervolemic Infusion Can Improve Splanchnic Perfusion in Elderly Patients During Laparoscopic Colorectal Surgery

Zhu

Deng

et al. 2018

Med Sci Monit

View full text Add to dashboard Cite

BackgroundThere is no adequate evidence on how the long duration of laparoscopic surgery affects splanchnic perfusion in elderly patients or the efficacy of acute hypervolemic fluid infusion (AHFI) during the induction of anesthesia. Our aim was to observe the effects of AHFI during the induction of general anesthesia on splanchnic perfusion.Material/MethodsSeventy elderly patients receiving laparoscopic colorectal surgery were randomly divided into three groups: lactated Ringer’s solution group (group R), succinylated gelatin group (group G), and hypertonic sodium chloride hydroxyethyl starch 40 injection group (group H). Thirty minutes after the induction of general anesthesia, patients received an infusion of target dose of these three solutions. Corresponding hemodynamic parameters, arterial blood gas analysis, and gastric mucosal carbon dioxide tension were monitored in sequences.ResultsIn all three groups, gastric-arterial partial CO2 pressure gaps (Pg–aCO2) were decreased at several beginning stages and then gradually increased, Pg–aCO2 also varied between groups due to certain time points. The pH values of gastric mucosa (pHi) decreased gradually after the induction of pneumoperitoneum in the three groups.ConclusionsThe AHFI of succinylated gelatin (12 ml/kg) during the induction of anesthesia can improve splanchnic perfusion in elderly patients undergoing laparoscopic surgery for colorectal cancer and maintain good splanchnic perfusion even after a long period of pneumoperitoneum (60 minutes). AHFI can improve splanchnic perfusion in elderly patients undergoing laparoscopic colorectal surgery.

show abstract

Pharmacokinetics and pharmacodynamics of cisatracurium in patients undergoing surgery with two hemodilution methods

Cited by 7 publications

References 23 publications

Hypervolemic Hemodilution as a Management During Predicted Massive Bleeding Sectio Caesarea in Placenta Accreta Patient

Hypervolemic Hemodilution as a Management During Predicted Massive Bleeding Sectio Caesarea in Placenta Accreta Patient

Observations on the Use of Different Modes of Cisatracurium Administration in Hyperthermic Intraperitoneal Chemotherapy

Acute Hypervolemic Infusion Can Improve Splanchnic Perfusion in Elderly Patients During Laparoscopic Colorectal Surgery

Contact Info

Product

Resources

About