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Pilot study on the influence of liver blood flow and cardiac output on the clearance of propofol in critically ill patients

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Abstract

Objective

To investigate the effect of cardiac output and liver blood flow on propofol concentrations in critically ill patients in the intensive care unit.

Methods

Five medical/surgical critically ill patients were enrolled in this preliminary study. Liver blood flow was measured using sorbitol. The cardiac output was measured by bolus thermodilution. NONMEM ver. V was applied for propofol pharmacokinetic analysis.

Results

The clearance of propofol was positively influenced by the liver blood flow (P < 0.005), whereas no significant correlation between cardiac output and propofol clearance was found. A correlation between liver blood flow and cardiac output or cardiac index could not be assumed in this patient group.

Conclusions

Liver blood flow is a more predictive indicator than cardiac output for propofol clearance in critically ill patients when the techniques of hepatic sorbitol clearance and bolus thermodilution, respectively, are used. Further study is needed to determine the role played by liver blood flow and cardiac output on the pharmacokinetics of highly extracted drugs in order to reduce the observed high interindividual variabilities in response in critically ill patients.

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Acknowledgements

We acknowledge the nursing staff of the Intensive Care Unit and the Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands. We especially thank J Burggraaf Ph.D., Leiden, The Netherlands and Emile Andriessen M.D., Anesthesiologist–intensivist for their help. All experiments comply with the current laws in The Netherlands, where the research was performed. Support was provided solely from institutional and departmental sources.

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Author notes

  1. Leon P. H. J. Aarts

    Present address: Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands

  2. Ferenc A. Boom

    Present address: Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, The Netherlands

Authors and Affiliations

  1. Department of Clinical Pharmacy, St. Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands

    Mariska Y. M. Peeters & Catherijne A. J. Knibbe

  2. Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands

    Leon P. H. J. Aarts, Ferenc A. Boom & Leo J. Bras

  3. Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands

    Dick Tibboel

  4. Division of Pharmacology, Leiden/Amsterdam Centre for Drug Research, Leiden University, Leiden, The Netherlands

    Meindert Danhof & Catherijne A. J. Knibbe

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  1. Mariska Y. M. Peeters
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  2. Leon P. H. J. Aarts
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Correspondence to Catherijne A. J. Knibbe.

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Peeters, M.Y.M., Aarts, L.P.H.J., Boom, F.A. et al. Pilot study on the influence of liver blood flow and cardiac output on the clearance of propofol in critically ill patients. Eur J Clin Pharmacol 64, 329–334 (2008). https://doi.org/10.1007/s00228-007-0399-9

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  • DOI: https://doi.org/10.1007/s00228-007-0399-9

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