title: Reinfusion of whole blood following addition of tobramycin powder to the wound during total knee arthroplasty.
abstract: This study prospectively examined nine human volunteers who underwent unilateral cementless total knee arthroplasty and had 600 mg of tobramycin powder added to their wound just prior to fascial closure. Serum levels of tobramycin were measured at 30 minutes, 4 hours, 8 hours, and 12 hours after surgery. Tobramycin levels in the reinfused whole blood were measured with each reinfusion. Patients were reinfused up to 12 hours after surgery and then the reservoir was left to suction drainage. All patients had significant levels of serum tobramycin 30 minutes after surgery. The average serum level was 5.5 micrograms/ml (range, 3.0-10.6 micrograms/ml). This level was achieved prior to any reinfusion and represented systemic absorption of tobramycin from the bleeding surfaces of the muscle and bone. All patients received at least one reinfusion of 400 ml of whole blood in the first 8 hours after surgery. Two thirds of the patients received a second reinfusion within the same time frame. Serum tobramycin levels measured post-reinfusion indicated that the risk of attaining potential toxic levels of aminoglycoside was not dependent on reinfusion, but on absorption from the wound. The dose of tobramycin in the drain was measured and found to be excessive and potentially toxic (range, 27-312 mg; average, 132 mg). Despite this fact, reinfusion was not as likely to produce toxic serum levels as was local uptake of the antibiotic. Although no patient in this series had any complaints relating to the high dose of tobramycin (deafness or renal failure), caution should be exercised when using antibiotics in a reinfusion system.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: DePaul Biomechanical Research Laboratory, Missouri Bone and Joint Center, St. Louis 63044.
authors.forename: P S
authors.initials: PS
authors.lastname: Lux
authors.forename: J W
authors.initials: JW
authors.lastname: Martin
authors.forename: L A
authors.initials: LA
authors.lastname: Whiteside
mesh_terms: D000287:Administration, Topical; D001804:Blood Transfusion, Autologous; D006801:Humans; D007430:Intraoperative Care; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D011446:Prospective Studies; D014031:Tobramycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D014031:Tobramycin