Thiopental Pharmacokinetics in Patients with Cirrhosis

Pandele, G I; Chaux, Felipe; Salvadori, C.; Farinotti, Mariangela; Duvaldestin, P.; Wyant, Gordon M.

doi:10.1097/00132586-198406000-00019

Cited by 11 publications

(12 citation statements)

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“…Metabolic clearance seems to have little influence on changes in elimination after bolus injection of thiopentone, as none was found in patients with liver cirrhosis (Pandele et al 1983) or in chronic alcoholics (Couderc et al 1984).…”

Section: Thiopentonementioning

confidence: 97%

Clinical Pharmacokinetic Considerations in the Treatment of Increased Intracranial Pressure

Heinemeyer

1987

Clinical Pharmacokinetics

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Life-threatening increased intracranial pressure can be reversed by a variety of drugs. These compounds all have some disadvantages, producing rebound effects, severe coma or cardiovascular depression and electrolyte imbalance. However, reduction of intracranial pressure is a prerequisite for recovery and the benefits of treatment outweigh the risks. Dexamethasone is rapidly eliminated, the short half-life (about 3 hours) indicating that dosage intervals should be kept small. As yet, however, its therapeutic efficacy has not been clearly demonstrated. Therefore, an association between pharmacokinetics and pharmacodynamics cannot be established. Osmotic diuretics are the most widely used agents for reduction of intracranial pressure. Pharmacokinetics show a very close relationship to changes in serum osmolality, but there are large variations in the clearance. For the use of osmotics, the blood-brain barrier must be intact. Osmotic diuretics may lead to intracerebral oedema or to acute renal failure as serum osmolality increases. Considering the pharmacokinetics of each drug, and the dynamics of intracerebral pressure and osmolality, an intermittent, individually titrated dosage should be administered, with simultaneous monitoring of intracranial pressure. Frusemide (furosemide) can be used as an adjunct, to enhance the effect of osmotic diuretics. Its pharmacokinetics are limited by renal function, depending on age as well as on the extent of renal impairment. Altered renal elimination of concomitantly administered drugs, and electrolyte imbalances should be anticipated when diuretics are used. Barbiturates are certain to decrease intracranial pressure in humans by an as yet unknown mechanism. Their administration is recommended for patients that do not respond to conventional therapy. As barbiturates can result in deep coma, knowledge of their pharmacokinetics is of great importance for recovery. Following single doses, pentobarbitone has a relatively long elimination half-life (about 22 hours). However, after repeated administration for several days, its elimination may be enhanced due to autoinduction. Thiopentone kinetics are characterised by distribution and redistribution into deep peripheral compartments. Administration of high and frequent doses leads to considerably delayed recovery. This is not true for methohexitone, which shows comparable pharmacokinetics after single and multiple dose administration. Elimination depends on liver blood flow. Thus, recovery from methohexitone-coma is rapid. Rapid elimination is also an important characteristic of etomidate and alphaxalone/alphadolone, two non-barbiturate hypnotics.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: Thiopentonementioning

confidence: 97%

Clinical Pharmacokinetic Considerations in the Treatment of Increased Intracranial Pressure

Heinemeyer

1987

Clinical Pharmacokinetics

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“…La clairance hépatique et le volume de distribution du thiopental ne sont pas notablement modifiés en cas de cirrhose compensée ou d'insuffisance hépatocellulaire modérée. Il en résulte que la demi-vie d'élimination n'est que modérément augmentée [38].…”

Section: Les Agents Hypnotiquesunclassified

Adaptation des thérapeutiques médicamenteuses en cas d’insuffisance hépatocellulaire

et al. 2007

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“…36 Methohexital, ketamine, 37 and etomidate, 38 which are all extensively metabolized by the liver, appear to have unchanged clearance ratios after single bolus administration; however, because of the body's increased volume of distribution, their half-life appears prolonged compared with controls. Similarly, propofol has an unchanged clearance even with extended propofol infusions, 39 but the elimination half-life and time to cessation of effect appear prolonged in patients with liver failure.…”

Section: Intraoperative Anesthetic and Drug Administrationmentioning

confidence: 99%

Anesthetic Considerations in Patients With Hepatic Failure

Garg¹

2005

International Anesthesiology Clinics

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A 48-year-old man with a history of Laennec's cirrhosis (Childs class B) and hepatitis C diagnosed 3 years previously, and with a history of thrombocytopenia and moderate/severe coagulopathy, presented for dental rehabilitation/tooth extraction secondary to dental caries. The patient had no active bleeding issues at the time of presentation. The patient had a history of ingestion of 1 pint of whiskey and a 12-pack of beer everyday for 20 years, although he stated he quit 2 years ago. He also had a history of smoking cigarettes (½ pack per day for 22 years) and was still actively smoking. He was taking regular medications of vitamin B12, 5 mg hydrocodone/500-mg acetaminophen tablets everyday, and esomeprazole (Nexium) for severe gastroesophageal reflux disease. The patient had other medical history of diverticulitis and had undergone colonoscopy with negative results. He had undergone lumbar surgery and facial surgery in the past with no complications noted. On initial presentation, the patient had known coagulopathy and platelet dysfunction. Laboratory values were obtained preoperatively and revealed mild hepatocellular damage (aspartate transaminase 110U/L, alanine transaminase 39U/L), synthetic dysfunction (bilirubin 2.2 mg/dL), mild hyperglycemia (133 mg/dL), significant coagulopathy (prothrombin time [PT] 21.2 seconds [international normalized ratio 1.8], partial prothrombin time [PTT] 32.7 seconds), and suspected thrombocytopenia. Platelet count was attempted on each of the different blood draws but was unable to be completed secondary to platelet clumping in each of the specimens. However, remarks by the laboratory indicated the numbers of platelets were judged to be decreased from normal levels based on slide analysis. This assessment appeared congruent with the patient's known coagulopathy.With the patient's known history, a type and cross was obtained preoperatively and the patient was prophylactically transfused with a 6 pack of platelets before being taken to the operating room (OR). Once in the OR, standard monitors, including oscillometric blood pressure cuff, finger probe pulse oximetry, and 5-lead electrocardiogram, were attached. The 45

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Thiopental Pharmacokinetics in Patients with Cirrhosis

Cited by 11 publications

References 0 publications

Clinical Pharmacokinetic Considerations in the Treatment of Increased Intracranial Pressure

Clinical Pharmacokinetic Considerations in the Treatment of Increased Intracranial Pressure

Adaptation des thérapeutiques médicamenteuses en cas d’insuffisance hépatocellulaire

Anesthetic Considerations in Patients With Hepatic Failure

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