Lauven P M, Lussi C, Ebeling B J
Institut für Anästhesiologie der Rheinischen-Friedrich-Wilhelms-Universität Bonn.
Anasth Intensivther Notfallmed. 1990 Oct;25(5):313-6.
With the introduction of repetitive or continuous catheter techniques in regional anaesthesia, potential systemic intoxication hazards have increased. Especially high dose techniques such as peridural anaesthesia or plexus brachialis blockade consecutively generate high blood levels. In this study, blood levels collected from 20 patients (36 +/- 19 y, 173 +/- 9 cm, 73 +/- 15 kg) after lumbar epidural anaesthesia with mepivacaine led to the development of a linear open one-compartment-model (VD,ss: 109 l, Cltot: 594 ml/min, t1/2abs: 13 min, t1/2 beta: 149 min). With that model, dosage strategies could be studied via computer simulation. A mepivacaine dosage regimen for lumbar epidural anaesthesia, consisting of 250 mg as an initial bolus dose and an infusion rate of 150 mg/h after 15 min, cumulated to maximum concentrations of 2.5-3.5 micrograms/ml after 150 min. Such an infusion regimen may lead to concentrations of more than 4 micrograms/ml if applied for longer than 4 h. The pharmacokinetic computer simulation proved to be precise and could be compared to the measured blood levels of mepivacaine.
随着区域麻醉中重复或连续导管技术的引入，潜在的全身中毒风险增加。特别是高剂量技术，如硬膜外麻醉或臂丛神经阻滞，会连续产生较高的血药浓度。在本研究中，对20例患者（年龄36±19岁，身高173±9cm，体重73±15kg）进行甲哌卡因腰段硬膜外麻醉后采集血药浓度，建立了线性开放一室模型（稳态分布容积：109L，总清除率：594ml/min，吸收半衰期：13min，消除半衰期：149min）。利用该模型，可通过计算机模拟研究给药策略。一种用于腰段硬膜外麻醉的甲哌卡因给药方案，初始推注剂量为250mg，15分钟后输注速率为150mg/h，150分钟后血药浓度累积至2.5 - 3.5μg/ml。如果应用超过4小时，这样的输注方案可能导致血药浓度超过4μg/ml。药代动力学计算机模拟结果证明是准确的，并且可以与实测的甲哌卡因血药浓度相比较。
