Perioperative Medicine  |   August 2016
Rapid Infusion of Hydroxyethyl Starch 70/0.5 but not Acetate Ringer’s Solution Decreases the Plasma Concentration of Propofol during Target-controlled Infusion
Author Notes
  • From the Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
  • This report was previously presented in part at the 17th Annual Scientific Meeting of Japanese Society of Intravenous Anesthesia in Hirosaki, Japan, on October 30, 2010, and at the 14th Eurosiva Annual Scientific Meeting in Amsterdam on June 10, 2011.
    This report was previously presented in part at the 17th Annual Scientific Meeting of Japanese Society of Intravenous Anesthesia in Hirosaki, Japan, on October 30, 2010, and at the 14th Eurosiva Annual Scientific Meeting in Amsterdam on June 10, 2011.×
  • Submitted for publication December 4, 2015. Accepted for publication April 27, 2016.
    Submitted for publication December 4, 2015. Accepted for publication April 27, 2016.×
  • Address correspondence to Dr. Masui: Department of Anesthesiology, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, Japan 359–8513. kenichi@masuinet.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Pharmacology
Perioperative Medicine   |   August 2016
Rapid Infusion of Hydroxyethyl Starch 70/0.5 but not Acetate Ringer’s Solution Decreases the Plasma Concentration of Propofol during Target-controlled Infusion
Anesthesiology 8 2016, Vol.125, 304-312. doi:10.1097/ALN.0000000000001184
Anesthesiology 8 2016, Vol.125, 304-312. doi:10.1097/ALN.0000000000001184
Abstract

Background: Rapid fluid infusion resulting in increased hepatic blood flow may decrease the propofol plasma concentration (Cp) because propofol is a high hepatic extraction drug. The authors investigated the effects of rapid colloid and crystalloid infusions on the propofol Cp during target-controlled infusion.

Methods: Thirty-six patients were randomly assigned to 1 of 3 interventions (12 patients per group). At least 30 min after the start of propofol infusion, patients received either a 6% hydroxyethyl starch (HES) solution at 24 ml·kg−1·h−1 or acetated Ringer’s solution at 24 or 2 ml·kg−1·h−1 during the first 20 min. In all groups, acetated Ringer’s solution was infused at 2 ml·kg−1·h−1 during the next 20 min. The propofol Cp was measured every 2.5 min as the primary outcome. Cardiac output, blood volume, and indocyanine green disappearance rate were determined using a pulse dye densitogram analyzer before and after the start of fluid administration. Effective hepatic blood flow was calculated as the blood volume multiplied by the indocyanine green disappearance rate.

Results: The rapid HES infusion significantly decreased the propofol Cp by 22 to 37%, compared to the Cp at 0 min, whereas the rapid or maintenance infusion of acetate Ringer’s solution did not decrease the propofol Cp. Rapid HES infusion, but not acetate Ringer’s solution infusion, increased the effective hepatic blood flow.

Conclusions: Rapid HES infusion increased the effective hepatic blood flow, resulting in a decreased propofol Cp during target-controlled infusion. Rapid HES infusion should be used cautiously as it may decrease the depth of anesthesia.