RT Book, Section
A1 Johnson, Ken
A2 Johnson, Ken B.
SR Print(0)
ID 1103964626
T1 Implications of Blood Loss on Anesthetic Drugs
T2 Clinical Pharmacology for Anesthesiology
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071736169
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1103964626
RD 2024/04/24
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.