Condello Ignazio, Santarpino Giuseppe, Fiore Flavio, Di Bari Nicola, Speziale Giuseppe, Moscarelli Marco, Nasso Giuseppe
Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.
Paracelsus Medical University, Nuremberg, Germany.
Interact Cardiovasc Thorac Surg. 2021 Oct 4;33(4):625-627. doi: 10.1093/icvts/ivab143.
There is limited evidence as to the pharmacokinetic changes expected in adults with extracorporeal technologies. Drugs may be taken up by various components of the cardiopulmonary bypass circuit itself. Issues include the increased volume of the circuit leading to haemodilution; the sequestration of lipophilic drugs within the circuit tubing; and the absorption of proteins, especially albumin, onto the circuit, which can result in increased free drug. However, in this context, the aspect of pharmacokinetics and pharmacodynamics during minimally invasive extracorporeal circulation has not been described and evidenced by scientific studies. In this single-centre control study of 60 patients undergoing isolated coronary artery bypass grafting, we present the results focused on postoperative albumin values and intraoperative propofol dosages in patients undergoing surgery with minimally invasive (n = 30) versus conventional extracorporeal circulation (n = 30). In the minimally invasive extracorporeal circulation group, a lower propofol dosage titrated to a bispectral index of 40-45 was used during coronary artery bypass grafting, and an improvement of postoperative concentration of serum albumin was observed compared to the conventional extracorporeal circulation group.
关于体外技术在成人中预期的药代动力学变化，证据有限。药物可能会被体外循环回路本身的各种组件摄取。问题包括回路容积增加导致血液稀释；亲脂性药物在回路管道内的隔离；以及蛋白质，尤其是白蛋白在回路上的吸附，这可能导致游离药物增加。然而，在这种情况下，微创体外循环期间的药代动力学和药效学方面尚未得到科学研究的描述和证实。在这项对60例接受孤立冠状动脉搭桥术的患者进行的单中心对照研究中，我们呈现了聚焦于接受微创（n = 30）与传统体外循环（n = 30）手术患者术后白蛋白值和术中丙泊酚剂量的结果。在微创体外循环组中，冠状动脉搭桥术期间使用了较低剂量的丙泊酚滴定至脑电双频指数为40 - 45，并且与传统体外循环组相比，观察到术后血清白蛋白浓度有所改善。
