Effect of acute hypervolemic hemodilution of 6% hydroxyethyl starch 130/0.4 on the EC50 of propofol at two clinical endpoints in patients

Li,Yuhong; Shan,Yue; Lin,Xuezheng

doi:10.3892/etm.2015.2886

Effect of acute hypervolemic hemodilution of 6% hydroxyethyl starch 130/0.4 on the EC50 of propofol at two clinical endpoints in patients

Authors:
- Yuhong Li
- Yue Shan
- Xuezheng Lin
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Affiliations: Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China, Department of Anesthesiology, Taizhou Central Hospital, Taizhou, Zhejiang 318000, P.R. China
Published online on: November 20, 2015 https://doi.org/10.3892/etm.2015.2886
Pages: 110-116
Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Preoperative acute hypervolemic hemodilution (AHHD) is a technique used in anesthesia to reduce the number of blood cells lost during intraoperative bleeding. The aim of the present study was to evaluate the effect of the hypervolemic hemodilution of 6% hydroxyethyl starch 130/0.4 on the EC50 of propofol at two clinical endpoints. A total of 20 patients undergoing AHHD following epidural anesthesia were studied, and 20 patients who did not receive hemodilution were used as a control group. All patients were American Society of Anesthesiologists grade I, aged 20‑40 years and undergoing hip arthroplasty surgery. In the AHHD group, 10 ml/kg lactated Ringer's solution was infused over 20 min at the same time as the epidural test dose. The infusion was followed by the infusion of 6% hydroxyethyl starch 130/0.4 over 30 min. Patients in the control group received 10 ml/kg Ringer's solution over 50 min. Propofol was then delivered by a Diprifusor target‑controlled infusion. The predicted blood and effect‑site propofol concentrations were recorded at loss of consciousness (LOC) and return of consciousness (ROC). Probit analysis was used to estimate the values for predicted blood and effect‑site concentrations at the two clinical endpoints. The results showed that the potency of propofol was decreased during AHHD. Compared with the controls, the predicted blood and effect‑site concentrations of propofol at LOC were higher in patients of the hemodilution group, resulting in higher EC50 values (P=0.001 and 0.025, respectively). At ROC, the effect‑site EC50 was 2.9 µg/ml [95% confidence interval (CI), 2.8‑3.0] in hemodilution patients and 2.5 µg/ml (95% CI, 2.2‑2.6) in control patients (P=0.001). With AHHD, the LOC time was significantly longer and the propofol dose was higher, while ROC times were comparable. In conclusion, AHHD increases the requirement for propofol at LOC and prolongs LOC time. Patients with AHHD recovered consciousness at higher effect‑site concentrations of propofol. Thus, the induction dose of propofol should be increased during AHHD.

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1	Mielke LL, Entholzner EK, Kling M, Breinbauer BE, Burgkart R, Hargasser SR and Hipp RF: Preoperative acute hypervolemic hemodilution with hydroxyethylstarch: An alternative to acute normovolemic hemodilution? Anesth Analg. 84:26–30. 1997. View Article : Google Scholar : PubMed/NCBI
2	Smith I, White PF, Nathanson M and Gouldson R: Propofol: An update on its clinical use. Anesthesiology. 81:1005–1043. 1994. View Article : Google Scholar : PubMed/NCBI
3	Liang H, Yang CX, Li H, Liu HZ and Wang HB: Effects of preoperative acute hypervolemic hemodilution on hypercoagulability of patients with colon cancer. Ai Zheng. 25:1256–1260. 2006.(In Chinese). PubMed/NCBI
4	Laks J, Pilon RN, Klovekorn WP, Anderson W, MacCallum JR and O'Connor NE: Acute hemodilution: Its effects on hemodynamics and oxygen transport in anesthetized man. Ann Surg. 180:103–109. 1974. View Article : Google Scholar : PubMed/NCBI
5	van den Oever HL, Dzoljic M, Ince C, Hollmann MW and Mokken FC: Orthogonal polarization spectral imaging of the microcirculation during acute hypervolemic hemodilution and epidural lidocaine injection. Anesth Analg. 103:484–487. 2006. View Article : Google Scholar : PubMed/NCBI
6	Kurdiumova NV, Parfenov AL, Fokin MS, Grinenko EA, Eliava ShSh, Kheĭreddin AS and Sazonov IA: Intensive care using hypervolemic hypertensive hemodilution in the acute period of subarachnoidal hemorrhages in patients with arterial aneurysms. Zh Vopr Neirokhir Im N N Burdenko. 2:48–53. 2006.(In Russian). PubMed/NCBI
7	Saricaoglu F, Akinci SB, Celiker V and Aypar U: The effect of acute normovolemic hemodilution and acute hypervolemic hemodilution on coagulation and allogeneic transfusion. Saudi Med J. 26:792–798. 2005.PubMed/NCBI
8	Zheng H, Wang J, Cao X, Zuo J and Liu J: Effect of acute hypervolemic hemodilution on the pharmacokinetics of propofol by target-controlled infusion. Zhonghua Ma Zui Xue Za Zhi. 24:418–421. 2004.(In Chinese).
9	Tauzin-Fin P, Vinçon G, Houdek MC, Demotes-Mainard F and Muscagorry JM: Pharmacokinetics of propofol injected after deliberate preoperative hemodilution. Ann Fr Anesth Reanim. 10:337–342. 1991.(In French). View Article : Google Scholar : PubMed/NCBI
10	Takizawa E, Takizawa D, Hiraoka H, Saito S and Goto F: Disposition and pharmacodynamics of propofol during isovolaemic haemorrhage followed by crystalloid resuscitation in humans. Br J Clin Pharmacol. 61:256–261. 2006. View Article : Google Scholar : PubMed/NCBI
11	He M, Gao F and Tian YK: Effect of acute non-normovolaemic hemodilution on sedation of propofol target controlled infusion. Lin Chuang Ma Zui Xue Za Zhi. 28:837–840. 2012.(In Chinese).
12	Tang J, Wu G and Peng L: Pharmacokinetics of propofol in patients undergoing total hip replacement: Effect of acute hypervolemic hemodilution. Anaesthesist. 60:835–840. 2011. View Article : Google Scholar : PubMed/NCBI
13	Marsh B, White M, Morton N and Kenny GN: Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth. 67:41–48. 1991. View Article : Google Scholar : PubMed/NCBI
14	Kumar R, Chakraborty I and Sehgal R: A prospective randomized study comparing two techniques of perioperative blood conservation: Isovolemic hemodilution and hypervolemic hemodilution. Anesth Analg. 95:1154–1161. 2002. View Article : Google Scholar : PubMed/NCBI
15	Johnson KB, Egan TD, Kern SE, White JL, McJames SW, Syroid N and Church T: The influence of hemorrhagic shock on propofol: a pharmacokinetic and pharmacodynamic analysis. Anesthesiology. 99:409–420. 2003. View Article : Google Scholar : PubMed/NCBI
16	Shrewsbury RP, Johnson LW and Oliver SR: Influence of moderate haemodilution with fluosol or normal saline on carbaryl disposition in Sprague-Dawley rats. J Pharm Pharmacol. 49:236–240. 1997. View Article : Google Scholar : PubMed/NCBI
17	Hiraoka H, Yamamoto K, Okano N, Morita T, Goto F and Horiuchi R: Changes in drug plasma concentrations of an extensively bound and highly extracted drug, propofol, in response to altered plasma binding. Clin Pharmacol Ther. 75:324–330. 2004. View Article : Google Scholar : PubMed/NCBI
18	Wouters PF, Van de Velde MA, Marcus MA, Deruyter HA and Van Aken H: Hemodynamic changes during induction of anesthesia with eltanolone and propofol in dogs. Anesth Analg. 81:125–131. 1995. View Article : Google Scholar : PubMed/NCBI
19	Leslie K, Sessler DI, Bjorksten AR and Moayeri A: Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg. 80:1007–1014. 1995. View Article : Google Scholar : PubMed/NCBI
20	Nollert G, Sperling J, Sakamoto T, Jaeger BR and Jonas RA: Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets. Thorac Cardiovasc Surg. 49:226–230. 2001. View Article : Google Scholar : PubMed/NCBI
21	Bhattacharya AA, Curry S and Franks NP: Binding of the general anesthetics propofol and halothane to human serum albumin high resolution crystal structures. J Biol Chem. 275:38731–38738. 2000. View Article : Google Scholar : PubMed/NCBI
22	Benet LZ and Hoener B: Changes in plasma protein binding have little clinical relevance. Clin Pharmacol Ther. 71:115–121. 2002. View Article : Google Scholar : PubMed/NCBI
23	Schuh FT: Influence of haemodilution on the potency of neuromuscular blocking drugs. Br J Anaesth. 53:263–265. 1981. View Article : Google Scholar : PubMed/NCBI
24	Katz RL, Stirt J, Murray AL and Lee C: Neuromuscular effects of atracurium in man. Anesth Analg. 61:730–734. 1982. View Article : Google Scholar : PubMed/NCBI
25	Dahaba AA, Rinnhofer S, Wang G, Xu X, Liu XY, Wu XM, Rehak PH and Metzler H: Influence of acute normovolaemic haemodilution on bispectral index monitoring and propofol dose requirements. Acta Anaesthesiol Scand. 52:815–820. 2008. View Article : Google Scholar : PubMed/NCBI
26	Upton RN, Ludbrook GL, Grant C and Martinez AM: Cardiac output is a determinant of the initial concentrations of propofol after short-infusion administration. Anesth Analg. 89:545–552. 1999. View Article : Google Scholar : PubMed/NCBI
27	Myburgh JA, Upton RN, Grant C and Martinez A: Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model. Intensive care med. 27:276–282. 2001. View Article : Google Scholar : PubMed/NCBI
28	Kurita T, Morita K, Kazama T and Sato S: Influence of cardiac output on plasma propofol concentrations during constant infusion in swine. Anesthesiology. 96:1498–1503. 2002. View Article : Google Scholar : PubMed/NCBI
29	Glen JB: The development of ‘Diprifusor’: A TCI system for propofol. Anesthesia. 53(Suppl 1): 13–21. 1998. View Article : Google Scholar
30	Swinhoe CF, Peacock JE, Glen JB and Reilly CS: Evaluation of the predictive performance of a ‘Diprifusor’ TCI system. Anaesthesia. 53(Suppl 1): 61–67. 1998. View Article : Google Scholar : PubMed/NCBI
31	Irwin MG, Hui TW, Milne SE and Kenny GN: Propofol effective concentration 50 and its relationship to bispectral index. Anaesthesia. 57:242–248. 2002. View Article : Google Scholar : PubMed/NCBI
32	Smith C, McEwan AI, Jhaveri R, Wilkinson M, Goodman D, Smith LR, Canada AT and Glass PS: The interaction of fentanyl on the Cp50 of propofol for loss of consciousness and skin incision. Anesthesiology. 81:820–828. 1994. View Article : Google Scholar : PubMed/NCBI
33	White M and Kenny GN: Intravenous propofol anesthesia using a computerized infusion system. Anaesthesia. 45:204–209. 1990. View Article : Google Scholar : PubMed/NCBI
34	Shafer SL and Gregg KM: Algorithms to rapidly achieve and maintain stable drug concentrations at the site of drug effect with a computer-controlled infusion pump. J Pharmacokinet Biopharm. 20:147–169. 1992. View Article : Google Scholar : PubMed/NCBI
35	Wilkes NJ, Woolf R, Mutch M, Mallett SV, Peachey T, Stephens R and Mythen MG: The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg. 93:811–816. 2001. View Article : Google Scholar : PubMed/NCBI