Correspondence  |   May 2017
In Reply
Author Notes
  • National Defense Medical College, Saitama, Japan (K.M.).
  • (Accepted for publication January 11, 2017.)
    (Accepted for publication January 11, 2017.)×
Article Information
Correspondence   |   May 2017
In Reply
Anesthesiology 5 2017, Vol.126, 986. doi:10.1097/ALN.0000000000001578
Anesthesiology 5 2017, Vol.126, 986. doi:10.1097/ALN.0000000000001578
We thank Adachi et al. for their interest in our article1  showing that a rapid infusion of hydroxyethyl starch (HES) but not acetate Ringer’s solution decreased plasma propofol concentration during target-controlled infusion. They have focused on the influence of rapid fluid infusion on propofol pharmacodynamics. As it is unlikely that a rapid fluid infusion of HES itself changes the anesthetic potency of propofol in the brain, we discuss the influence of HES on the pharmacokinetics of propofol.
There is a good study by Takizawa et al.2  for this issue. Briefly, this study clarified that a 30 ml/kg but not a 10 ml/kg isovolemic hemorrhage followed by crystalloid resuscitation significantly increased the unbound fraction of propofol in blood and also showed that a 10 ml/kg isovolemic hemorrhage did not decrease the bispectral index (BIS) value. Their results suggest that an 8 ml/kg rapid fluid administration without hemorrhage in our study1  is unlikely to have increased the ratio of unbound propofol in blood. As a rapid infusion of 8 ml/kg HES decreased total plasma concentration of propofol in our study,1  there is a possibility of anesthetic awareness under propofol anesthesia during a rapid infusion of HES.
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