ORIGINAL ARTICLES   Free access

Minerva Anestesiologica 2013 November;79(11):1238-47

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Influence of acute normovolemic hemodilution on the pharmacokinetics of Cisatracurium Besylate

Dahaba A. A. ¹, Suljevic I. ², Oettl K. ³, Xiao Z. ⁴, Dong H. ⁴, Xiong L. ⁴, Reibnegger G. ³ ✉

¹ Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria; ² Department of Anesthesiology, Sarajevo University Clinical Centre, Sarajevo, Bosnia Herzegovina; ³ Department of Physiological Chemistry, Medical University of Graz, Graz, Austria; ⁴ Department of Anesthesiology, Xijing First Affiliated Hospital of Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China

Background: Acute normovolemic hemodilution (ANH) is an efficacious blood conservation strategy for avoiding or reducing allogeneic blood transfusion. In a previous publication, on a different cohort of patients, we demonstrated that cisatracurium’s potency and duration of action were not influenced by ANH, but we could not establish which role, if any, pharmacokinetics played.
Methods: Forty patients were randomly allocated to the ANH or control groups. Patients received cisatracurium single 100 µg kg-1 bolus dose, serial arterial blood samples were collected and assayed for pharmacokinetic analysis.
Results: Central and steady state apparent volumes of distribution (V1, Vdss) and slope factor (γ) were larger, effect-compartment concentration at 50% neuromuscular block was lower in the ANH (90.8±41.6 mL kg-1, 159.1±39.2 mL kg-1, 6.0±0.9 and 136.4±29.1 ng·mL-1) compared with the control group (65.5±26.1 mL kg-1, 134.8±31.8 mL kg-1, 5.5±0.8 and 158.5±26.0 ng·mL-1) respectively. Elimination half-life (t1/2 β) and mean residence time (MRT) were longer in the ANH (37.2±20.9, 23.5±13.2 min) than the control group (26.8±9.8, 16.9±6.2 min), albeit not statistically significant (P=0.051, P=0.051). There were no significant differences in distribution half-life (t1/2 α), effect-compartment equilibration rate-constant (keo), central and total clearances (Clc, Cl) between the ANH (2.4±1.2 min, 0.070±0.013 min-1, 6.1±1.9 mL kg-1 min-1 and 7.7±2.3 mL kg-1 min-1) and control group (1.9±1.2 min, 0.063±0.008 min-1, 7.0±1.8 mL kg-1 min-1 and 8.5±2.1 mL kg-1 min-1) respectively.
Conclusion: ANH altered some pharmacokinetic parameters such as significantly larger volumes of distribution. Other parameters such as elimination half-life were considerably longer albeit not statistically significant.