1. Population-based volume kinetics of Ringer’s lactate solution in patients undergoing open gastrectomy
- Author
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Joo-Hyun Lee, Jin-Ho Rhim, Gyu-Jeong Noh, Yong Hun Lee, Yeong-Jin Choo, Soo-Han Lee, Byung Moon Choi, Kyu-Taek Choi, and Sung-Tae Oh
- Subjects
Adult ,Male ,0301 basic medicine ,Mean arterial pressure ,Ringer's Lactate ,Remifentanil ,Article ,Hemoglobins ,03 medical and health sciences ,0302 clinical medicine ,Pharmacokinetics ,Gastrectomy ,Heart Rate ,medicine ,Humans ,Arterial Pressure ,Pharmacology (medical) ,Infusions, Intravenous ,Aged ,Aged, 80 and over ,Pharmacology ,Volume of distribution ,Chemistry ,Body Weight ,General Medicine ,Middle Aged ,Dilution ,Kinetics ,030104 developmental biology ,Blood pressure ,030220 oncology & carcinogenesis ,Anesthesia ,Arterial blood ,Female ,Propofol ,medicine.drug - Abstract
In order to maintain stable blood pressure and heart rate during surgery, anesthesiologists need to administer the appropriate amount of fluid with appropriate fluid type to the patient, then quantifying how fluid is distributed and eliminated from the body is useful for establishing a fluid administration strategy. In this study we characterized the volume kinetics of Ringer’s lactate solution in patients undergoing open gastrectomy. When propofol and remifentanil reached a pseudosteady state at the target concentration and blood pressure was stabilized following surgical stimulation, enrolled patients were administered 1000 mL of Ringer’s lactate solution for 20 min, followed by continuous infusion at a rate of 6 mL/kg/h until the time of the last blood collection for volume kinetic analysis. Arterial blood samples were collected to measure the hemoglobin concentration at different time points. The change in hemoglobin-derived plasma dilution induced by the administration of Ringer’s lactate solution was evaluated by nonlinear mixed effects modeling. Three hundred and twenty-three plasma dilution data points from 27 patients were used to determine the pharmacokinetic characteristics of Ringer’s lactate solution. A two-volume model best described the pharmacokinetics of Ringer’s lactate solution. The mean arterial pressure (MAP) and body weight (WT) were significant covariates for the elimination clearance (k(r)) and central volume of distribution at baseline (V(c0)), respectively. The parameter estimates were as follows: k(r) (mL/min) = 124 + (MAP/70)(14.2), V(c0) (mL) = 0.95 + 3440 × (WT/63), V(t0) (mL) = 2730, and k(t) (mL/min) = 181. A higher MAP was associated with a greater elimination clearance and, consequently, less water accumulation in the interstitium. As body weight increases, volume expansion in the blood vessels increases.
- Published
- 2018