[The significance of the sampling site in the determination of plasma levels of local anesthetics using 0.75% bupivacaine as an example].

IF 1.9 Q2 POLITICAL SCIENCE Regional-Anaesthesie Pub Date : 1990-01-01
B Bachmann-M, J Biscoping, H A Adams, T Menges, W Krumholz, G Hempelmann
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Abstract

Knowledge of the actual concentrations of local anesthetic administered by various techniques is essential requisite when undesirable side effects and possible toxicity of a substance are to be evaluated. Therefore, numerous studies of plasma concentrations have been presented, which were carried out with the additional purpose of analyzing the kinetics of different local anesthetics with respect to limiting-value concentrations in the organism. Despite a sufficient degree of precision in the analysis of amide local anesthetics, it is uncertain whether the results of the different studies are comparable, because blood samples have been taken variously from peripheral veins, central veins or arteries. In the present study changes in bupivacaine concentrations were monitored by means of a standardized method consisting in simultaneous sampling of blood in peripheral veins, central veins and arteries. METHODS. Each of 12 patients undergoing orthopedic hip surgery received average 17 ml bupivacaine (0.75%) via peridural lumbar catheter. After the administration of bupivacaine, blood samples were taken simultaneously from peripheral veins, central veins and arteries at 1, 3, 5, 10, 15, 30, 45, 60, and 90 min after injection. Placement of an arterial cannula and central venous catheter was indicated in all patients (hip-joint revision arthroplasty). Quantitative analysis of bupivacaine concentration was carried out by means of high-pressure liquid chromatography (HPLC). All patients had given their informed consent. RESULTS. All patients showed a rapid increase in bupivacaine concentration in the central venous blood within the first few minutes after administration, the maximum being reached between 3 and 10 min after. A similar course was observed with arterial plasma concentrations; absolute values, however, were an average of 10-20% lower at 15 min following administration. Bupivacaine concentrations in peripheral veins rose more slowly and reached a maximum between 15 and 30 min. At 30 min after peridural application the concentration curves in blood from all three sites were similar. DISCUSSION. In earlier studies the influence of the site of blood sampling has often been underestimated. According to our results, central venous and arterial plasma concentrations correspond closely at all times following peridural application. The observed uniform differences in concentrations at the various sites of sampling can be explained by the fact that pulmonary uptake of local anesthetics causes the lower arterial levels. Especially in the early phase of resorption after administration of local anesthetics, the concentration in peripheral blood does not seem to be representative, because an equilibrium is not established between arterial and central venous blood until 30 min after administration at the earliest. In our opinion the peripheral venous concentrations are unreliable, particularly in the early phases, for the evaluation of unwanted effects or toxicity of local anesthetics, because the initial low values and the delayed increase in these could lead to a false sense of security.

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[以0.75%布比卡因为例,取样部位在局麻药血浆浓度测定中的意义]。
当评估一种物质的不良副作用和可能的毒性时,了解通过各种技术施用的局麻药的实际浓度是必不可少的。因此,已经提出了许多关于血浆浓度的研究,这些研究的另一个目的是分析不同局麻药在机体内的限值浓度的动力学。尽管对酰胺类局部麻醉剂的分析具有足够的精确度,但不同研究的结果是否具有可比性尚不确定,因为血液样本取自不同的外周静脉、中心静脉或动脉。在本研究中,布比卡因浓度的变化是通过一种标准化的方法来监测的,该方法包括同时采集外周静脉、中心静脉和动脉的血液。方法。12例髋关节矫形手术患者,平均每人经硬膜外腰导管布比卡因17 ml(0.75%)。布比卡因给药后,于注射后1、3、5、10、15、30、45、60、90 min同时取外周静脉、中心静脉和动脉血样。所有患者(髋关节翻修置换术)均需放置动脉插管和中心静脉导管。采用高压液相色谱法对布比卡因的浓度进行了定量分析。所有患者均给予知情同意。结果。所有患者在给药后几分钟内中心静脉血布比卡因浓度迅速升高,在给药后3 - 10分钟达到最大值。动脉血浆浓度也有类似的过程;然而,在给药后15分钟,绝对值平均降低10-20%。外周静脉布比卡因浓度上升较慢,在15 - 30分钟达到最大值。在硬膜外应用后30分钟,三个部位的血液浓度曲线相似。讨论。在早期的研究中,采血地点的影响常常被低估。根据我们的结果,中心静脉和动脉血浆浓度在硬膜外应用后的任何时候都密切相关。在不同采样点观察到的浓度的均匀差异可以用肺对局部麻醉剂的摄取导致较低的动脉水平这一事实来解释。特别是在局麻药后吸收的早期,外周血浓度似乎不具有代表性,因为最早要到给药后30min动脉血和中心静脉血之间才建立平衡。在我们看来,外周静脉浓度是不可靠的,特别是在早期阶段,用于评估局麻药的不良影响或毒性,因为最初的低值和延迟的增加可能导致错误的安全感。
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[An epidural spinal abscess as a lethal complication of peridural anesthesia]. [Knotting of a peridural catheter]. [A simple technique for estimating the level of analgesia in regional anesthesia]. [CSE--the combination of spinal and epidural anesthesia]. [Comments on the paper by R. Schürg et al. Maternal and neonatal plasma concentrations of bupivacaine during peridural anesthesia for cesarean section].
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