Rapid Infusion of Hydroxyethyl Starch 70/0.5 but not Acetate Ringer's Solution Decreases the Plasma Concentration of Propofol during Target-controlled Infusion.
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·h or acetated Ringer's solution at 24 or 2 ml·kg·h during the first 20 min. In all groups, acetated Ringer's solution was infused at 2 ml·kg·h 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.
From the Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Sayako
S
Itakura
Kenichi
K
Masui
Tomiei
T
Kazama
D000328:Adult; D000368:Aged; D001810:Blood Volume / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D000077324:Crystalloid Solutions; D016503:Drug Delivery Systems; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000494:pharmacology*; D006993:Hypnotics and Sedatives / Q000097:blood*; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000494:pharmacology*; D008102:Liver Circulation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D015742:Propofol / Q000097:blood*; D000077331:Ringer's Solution; D016896:Treatment Outcome
D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D006993:Hypnotics and Sedatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077331:Ringer's Solution; D015742:Propofol