TY - CHAP M1 - Book, Section TI - Implications of Blood Loss on Anesthetic Drugs A1 - Johnson, Ken A2 - Johnson, Ken B. PY - 2015 T2 - Clinical Pharmacology for Anesthesiology AB - An interesting case report published in 2002 perhaps best sets the stage for understanding what anesthesiologists face when caring for a patient who suffers from severe blood loss while under an anesthetic.1 In this case report, a 70-year-old woman is anesthetized using a total intravenous technique with propofol and alfentanil for an elective aortic abdominal aneurysm repair. Routine monitors and a Bispectral Index Scale (BIS) monitor were used. The patient was enrolled as a study subject exploring the antioxidant effects of propofol. The procedure and anesthetic were unremarkable until after the cross-clamp was removed; then, the BIS values dropped first (mid-30s to below 20) followed 7 minutes later by a blood pressure drop (systolic pressure fell from about 120 to about 60 mm Hg) (Figure 23–1). Results from the measured plasma propofol concentrations were also very compelling. At the time of cross-clamping, target and measured propofol concentrations were 5.0 and 4.7 mcg/mL, respectively. After the cross-clamp was removed, they were 3.0 and 7.2 mcg/mL, respectively. Thus, even though clinicians sought to decrease propofol dosing, plasma concentrations were more than double the desired level. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1103964626 ER -