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Chapter 25 - The Effects of Cardiopulmonary Bypass on Drug Pharmacology

from Section 5 - Cardiopulmonary Bypass

Published online by Cambridge University Press:  12 May 2020

By
Jens Fassl  and
Berend Mets
Edited by
Joseph Arrowsmith ,
Andrew Roscoe  and
Jonathan Mackay
Joseph Arrowsmith
Affiliation:
Royal Papworth Hospital, Cambridge
Andrew Roscoe
Affiliation:
Singapore General Hospital
Jonathan Mackay
Affiliation:
Royal Papworth Hospital, Cambridge
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Summary

The institution of CPB has profound effects on the plasma concentration, distribution and elimination of drugs. The major factors responsible for this are haemodilution, altered plasma protein binding, altered regional blood flow, hypothermia, isolation of the lungs from the circulation and sequestration of drugs into components of the extracorporeal circuit. These changes, which are influenced by physicochemical and pharmacokinetic characteristics, result in an alteration in free drug and effector-site concentration.

Type
Chapter
Information
Core Topics in Cardiac Anaesthesia , pp. 199 - 202
Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Goucke, CR, Hackett, LP, Barrett, PH, Ilett, KF. Blood concentrations of enflurane before, during, and after hypothermic cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2007; 21: 218–23.CrossRefGoogle ScholarPubMed
Mets, B, Reich, NT, Mellas, N, Beck, J, Park, S. Desflurane pharmacokinetics during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2001; 15: 179–82.CrossRefGoogle ScholarPubMed
Mets, B. The pharmacokinetics of anesthetic drugs and adjuvants during cardiopulmonary bypass. Acta Anaesthesiol Scand 2000; 44: 261–73.CrossRefGoogle ScholarPubMed
Nussmeier, NA, Lambert, ML, Moskowitz, GJ, et al. Washin and washout of isoflurane administered via bubble oxygenators during hypothermic cardiopulmonary bypass. Anesthesiology 1989; 71: 519–25.CrossRefGoogle ScholarPubMed
Sherwin, J, Heath, T, Watt, K. Pharmacokinetics and dosing of anti-infective drugs in patients on extracorporeal membrane oxygenation: a review of the current literature. Clin Ther 2016; 38: 1976–94.CrossRefGoogle ScholarPubMed
Takizawa, E., Hiraoka, H., Takizawa, D., Goto, F. Changes in the effect of propofol in response to altered plasma protein binding during normothermic cardiopulmonary bypass. Br J Anaesth 2006; 96: 179–85.CrossRefGoogle ScholarPubMed
van Saet, A, de Wildt, SN, Knibbe, CA, et al. The effect of adult and pediatric cardiopulmonary bypass on pharmacokinetic and pharmacodynamic parameters. Curr Clin Pharmacol 2013; 8: 297–318.CrossRefGoogle ScholarPubMed

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