Pharmacokinetics and pharmacodynamics of intravenous midazolam in patients with severe alcoholic cirrhosis.

MacGilchrist, Alastair; Birnie, G G; Cook, Abigail; Scobie, G; Murray, Thomas G.; Watkinson, G.; Brodie, Martin J.

doi:10.1136/gut.27.2.190

Cited by 135 publications

(54 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Wu et al (2013) demonstrated that patients with liver dysfunction required less propofol to attain an equal anesthetic level guided by the BIS. Our results are consistent with those from the pharmacodynamic study of volatile anesthetics by Yang et al (2010), and the studies by MacGilchrist et al (1986) and Wu et al (2013). Different results might arise partly from differences in study protocols.…”

Section: Fig 1 Probability Of Unconsciousness Versus the Bis Values supporting

confidence: 82%

“…MacGilchrist et al (1986) showed that alcoholic cirrhosis was associated with significantly delayed elimination of MDZ and greater sedation after intravenous administration of MDZ. In a later study, Pentikäinen et al (1989) reported that the elimination of MDZ was significantly retarded, but not the hypnotic effects, in patients with cirrhosis.…”

Section: Fig 1 Probability Of Unconsciousness Versus the Bis Values mentioning

confidence: 99%

“…Previous studies have shown that both the pharmacokinetics (MacGilchrist et al, 1986;Pentikäinen et al, 1989) and pharmacodynamics (MacGilchrist et al, 1986) of MDZ were significantly impaired in patients with hepatic cirrhosis. The effects of liver function on sensitivity to MDZ and prediction of the BIS for loss of consciousness (LOC) remain unclear.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Ruan

2014

J. Zhejiang Univ. Sci. B

View full text Add to dashboard Cite

Abstract:Objective: To explore the effect of hepatic function on loss of consciousness (LOC) and bispectral index (BIS) during sedation with midazolam (MDZ). Methods: Forty-five patients were assigned to three groups according to their liver function. Thirty of these patients with diagnoses of cholelithiasis were scheduled laparoscopic cholecystectomy, including 15 patients with normal liver function (normal group), and 15 patients with moderately abnormal liver function based on the results of ultrasonic diagnosis of a moderately fatty liver and elevated alanine transaminase levels of less than three times normal (moderate group). The other 15 patients with end-stage liver disease (severe group) underwent liver transplantation. Each patient was administered MDZ by way of target-controlled infusion to increase the concentration gradually. At the time of LOC, the BIS was recorded and a blood sample was withdrawn for measurement of the concentration of MDZ. The concentration of MDZ (EC 50 ) and the BIS value (BIS 50 ) at which 50% of patients lose consciousness were calculated using logistic regression. Results: At the time of LOC, the EC 50 of MDZ and the BIS 50 were similar in the normal and moderate groups (P>0.05). LOC occurred at a lower EC 50 of MDZ and at a higher BIS 50 in the severe group, compared with the normal and moderate groups (P<0.01). Conclusions: Patients with end-stage liver disease were more sensitive to MDZ and this affected the prediction of their time of LOC following MDZ administration. There were no changes in response in patients with moderately abnormal hepatic function.

show abstract

Section: Fig 1 Probability Of Unconsciousness Versus the Bis Values supporting

confidence: 82%

Section: Fig 1 Probability Of Unconsciousness Versus the Bis Values mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Ruan

2014

J. Zhejiang Univ. Sci. B

View full text Add to dashboard Cite

show abstract

“…In patients with liver disease caused by alcoholic cirrhosis the pharmacokinetic changes vary between studies. Some report little change [20-221 while others report large changes [5]. This study may offer one explanation for these differences in seemingly similar patients.…”

Section: G R Park and E Millermentioning

confidence: 84%

“…As a substrate for CYP 3A we used midazolam [4]. This is a widely used sedative, known to be affected by liver disease [5] and critical illness …”

mentioning

confidence: 99%

What changes drug metabolism in critically ill patients‐III? Effect of pre‐existing disease on the metabolism of midazolam

Park

Miller

1996

Anaesthesia

View full text Add to dashboard Cite

show abstract

Pharmacokinetics of minoxidil in patients with cirrhosis and healthy volunteers

Adams

Poynor

Garnett

et al. 1998

Biopharm. Drug Dispos.

View full text Add to dashboard Cite

Pharmacokinetics and pharmacodynamics of intravenous midazolam in patients with severe alcoholic cirrhosis.

Cited by 135 publications

References 24 publications

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

What changes drug metabolism in critically ill patients‐III? Effect of pre‐existing disease on the metabolism of midazolam

Pharmacokinetics of minoxidil in patients with cirrhosis and healthy volunteers

Contact Info

Product

Resources

About