Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
8 - Blood Loss: Does It Change My Intravenous Anesthetic?
Published online by Cambridge University Press: 18 January 2010
Edited by
Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
Summary
Objectives
Review emerging data on the influence of blood loss and resuscitation on the behavior of commonly used intravenous sedative hypnotics and opioids.
Discuss the rational selection and dosing of sedative hypnotics and opioids in settings of intravascular volume depletion.
SUMMARY
Anesthesiologists have long recognized the need to moderate doses of intravenous anesthetics in settings of significant blood loss. The scientific rationale for this practice, however, has not been well established. This chapter reviews recent investigations that have quantified how blood loss influences intravenous anesthetic behavior and synthesizes these findings into a set of clinical “take-home messages” targeted at improving patient safety.
INFLUENCE OF BLOOD LOSS ON INTRAVENOUS ANESTHETICS
Dr. Halford, a surgeon, wrote a letter to the editor of Anesthesiology after caring for several trauma victims after the attack on Pearl Harbor in 1941. He noticed that anesthetists had started using the intravenous (IV) anesthetic sodium pentothal. His comments were:
Then let it be said that intravenous anesthesia is also an ideal form of euthanasia … With this heterogeneous mass of emergency anesthetists, it is necessary to choose an anesthetic involving the WIDEST MARGIN OF SAFETY for the patient … Stick with ETHER [1].
Anesthesiologists have recognized the need to incrementally dose these anesthetics, and to moderate the overall dose for patients who have significant blood loss before or during surgery. Through experience, they have learned that a full dose of certain IV anesthetics can lead to pronounced and often unwanted side effects with potentially disastrous consequences.
- Type
- Chapter
- Information
- Trauma Anesthesia , pp. 133 - 141Publisher: Cambridge University PressPrint publication year: 2008
References
A critique of intravenous anesthesia in war surgery. Anesthesiology 1943;4: 67–9CrossRefGoogle Scholar
, , , . The influence of hemorrhagic shock on the pharmacokinet and the analgesic effect of morphine in the rat. Fundam Clin Pharmacol 1998;12: 624–30.CrossRefGoogle Scholar
, , , , , . Fentanyl pharmacokinetics in hemorrhagic shock: A porcine model. Anesthesiology 1999;91: 156–6.CrossRefGoogle ScholarPubMed
, , , , , . Influence of hemorrhagic shock on remifentanil; a pharmacokinetic and pharmacodynamic analysis. Anesthesiology 2001;94: 322–32.CrossRefGoogle ScholarPubMed
, , , , The influence of hemorrhagic shock on ketamine: a pharmacokinetic analysis. Anesthesiology 2006; ASA Annual Meeting Abstracts A203.Google Scholar
, , , , , : Influence of hypovolemia on the pharmacokinetics and the electroencephalographic effect of propofol in the rat. Anesthesiology 2000;93: 1482–90.CrossRefGoogle ScholarPubMed
, , , , . Influence of hypovolemia on the pharmacokinetics and the electroencephalographic effect of etomidate in the rat. J Pharmacol Exp Ther 1999;290: 1048–53.Google ScholarPubMed
, , , , , Influence of hemorrhagic shock followed by crystalloid resuscitation on propofol: A pharmacokinetic and pharmacodynamic analysis. Anesthesiology 2004.;101: 647–59.CrossRefGoogle ScholarPubMed
, , , , , , , The influence of hemorrhagic shock on propofol: A pharmacokinetic and pharmacodynamic analysis. Anesthesiology 2003;99: 409–20.CrossRefGoogle ScholarPubMed
, , , , , . The influence of hemorrhagic shock on etomidate: A pharmacokinetic and pharmacodynamic analysis. Anesth Analg 2003;96: 1360–8.CrossRefGoogle ScholarPubMed
, Kinetics of drug action in disease states. XXV. Effect of experimental hypovolemia on the pharmacodynamics and pharmacokinetics of desmethyldiazepam. J Pharmacol Exp Ther 1988;245: 508–12.Google ScholarPubMed
, , , Cardiovascular and metabolic sequelae of inducing anesthesia with ketamine or thiopental in hypovolemic swine. Anesthesiology 1984;60: 214–19.CrossRefGoogle ScholarPubMed
, , , , , Midazolam pharmacodynamics and pharmacokinetics during acute hypovolemia. Anesthesiology 1985;63: 140–6.CrossRefGoogle ScholarPubMed
, , , Lidocaine disposition kinetics in monkey and man II. Effect of hemorrhage and sympathomimetic drug administration. Clin Pharmacol Ther 1973;16: 99–109.CrossRefGoogle Scholar
, , , , , . Optimal propofol-alfentanil combinations for supplementing nitrous oxide for outpatient surgery. Anesthesiology 1999;91: 97–108.CrossRefGoogle ScholarPubMed
, , The pharmacodynamic interaction between propofol and fentanyl with respect to the suppression of somatic or hemodynamic responses to skin incision, peritoneum incision, and wall retraction. Anesthesiology 1998;89: 894–906.CrossRefGoogle ScholarPubMed
, , , , , , . Endorphins in primate hemorrhagic shock: Beneficial action of opiate antagonists. J Surg Res 1986;40: 265–75.CrossRefGoogle ScholarPubMed
Opiate modulation of hemodynamic, hormonal, and cytokine response to hemorrhage. Shock 2001;15: 471–8.CrossRefGoogle ScholarPubMed
, beta-Endorphins in canine hemorrhagic shock. Surg Gynecol Obstet 1986;163: 137–44.Google ScholarPubMed
, Formulation-dependent pharmacokinetics and pharmacodynamics of propofol in rats. J Pharm Pharmacol 1998;50: 37–42.CrossRefGoogle ScholarPubMed
, , , , , , , . Ability of the bispectral index, autoregressive modelling with exogenous input-derived auditory evoked potentials, and predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifentanil. Anesthesiology 2003;99: 802–12.CrossRefGoogle ScholarPubMed
, , Left ventricular systolic and diastolic function is unaltered during propofol infusion in newborn swine. Anesth Analg 1998;86: 717–23.CrossRefGoogle ScholarPubMed
, Cardiovascular effects of propofol in the anaesthetized dog. Br J Anesth 1989;63: 87–92.CrossRefGoogle ScholarPubMed
, , , , , Hemodynamic and cardiodynamic effects of propofol and etomidate: Negative inotropic properties of propofol. Anesth Analg 1989;69: 35–40.Google ScholarPubMed
, . Negative inotropic effects of propofol as evaluated by the regional preload recruitable stroke work relationship in chronically instrumented dogs. Anesthesiology 1993;78: 100–108.CrossRefGoogle ScholarPubMed
, . Understanding the dose-effect relationship: Clinical application of pharmacokinetic-pharmacodynamic models. Clin Pharmacokinet 1981;6: 429–53.CrossRefGoogle ScholarPubMed