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Effect of Bronchoco...
Effect of Bronchoconstriction-induced Ventilation-Perfusion Mismatch on Uptake and Elimination of Isoflurane and Desflurane
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- Kretzschmar, Moritz (författare)
- Uppsala universitet,Hedenstiernalaboratoriet,Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany
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- Kozian, Alf, 1969- (författare)
- Uppsala universitet,Hedenstiernalaboratoriet,Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany
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- Baumgardner, James E (författare)
- Oscill LLC, Pittsburgh, PA USA; Univ Pittsburgh, Med Ctr, Dept Anesthesiol, Pittsburgh, PA USA
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- Borges, João Batista, 1966- (författare)
- Uppsala universitet,Hedenstiernalaboratoriet
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- Hedenstierna, Göran, 1941- (författare)
- Uppsala universitet,Klinisk fysiologi
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- Larsson, Anders (författare)
- Uppsala universitet,Hedenstiernalaboratoriet
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- Hachenberg, Thomas (författare)
- Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany
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- Schilling, Thomas, 1966- (författare)
- Uppsala universitet,Hedenstiernalaboratoriet,Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany
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(creator_code:org_t)
- 2017
- 2017
- Engelska.
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Ingår i: Anesthesiology. - 0003-3022 .- 1528-1175. ; 127:5, s. 800-812
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- BACKGROUND: Increasing numbers of patients with obstructive lung diseases need anesthesia for surgery. These conditions are associated with pulmonary ventilation/perfusion (VA/Q) mismatch affecting kinetics of volatile anesthetics. Pure shunt might delay uptake of less soluble anesthetic agents but other forms of VA/Q scatter have not yet been examined. Volatile anesthetics with higher blood solubility would be less affected by VA/Q mismatch. We therefore compared uptake and elimination of higher soluble isoflurane and less soluble desflurane in a piglet model.METHODS: Juvenile piglets (26.7 ± 1.5 kg) received either isoflurane (n = 7) or desflurane (n = 7). Arterial and mixed venous blood samples were obtained during wash-in and wash-out of volatile anesthetics before and during bronchoconstriction by methacholine inhalation (100 μg/ml). Total uptake and elimination were calculated based on partial pressure measurements by micropore membrane inlet mass spectrometry and literature-derived partition coefficients and assumed end-expired to arterial gradients to be negligible. VA/Q distribution was assessed by the multiple inert gas elimination technique.RESULTS: Before methacholine inhalation, isoflurane arterial partial pressures reached 90% of final plateau within 16 min and decreased to 10% after 28 min. By methacholine nebulization, arterial uptake and elimination delayed to 35 and 44 min. Desflurane needed 4 min during wash-in and 6 min during wash-out, but with bronchoconstriction 90% of both uptake and elimination was reached within 15 min.CONCLUSIONS: Inhaled methacholine induced bronchoconstriction and inhomogeneous VA/Q distribution. Solubility of inhalational anesthetics significantly influenced pharmacokinetics: higher soluble isoflurane is less affected than fairly insoluble desflurane, indicating different uptake and elimination during bronchoconstriction.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
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