British Journal of Anaesthesia, Vol 81, Issue 4 495-501, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia
JFA. Hendrickx, AAJ. Van Zundert and A. M. De Wolf
Sevoflurane uptake (Vsevo) can be predicted by the square root of time
model or the four-compartment model. However, Vsevo and the effect of
cardiac output on anaesthetic uptake have not been quantified clinically.
After obtaining IRB approval and informed consent, 34 adult patients
received closed-circuit anaesthesia with sevoflurane for 1 h. The
end-expired sevoflurane concentration was maintained at 2.6% by infusion of
liquid sevoflurane into the breathing system. In a subgroup of 12 patients,
cardiac output was measured every 5 min by thermodilution (CO group). The
effect of patient characteristics (age, height, weight, body surface area)
and cardiac output on Vsevo were determined, and Vsevo was compared with
the theoretical models. In the CO group, measured cardiac output was used
in the formulae of these models. A two-exponential curve described average
Vsevo well: Vsevo (ml liquid) = 0 + 1.62 x (1 - e(-2.3)xt) + 18.1 x (1 -
e(-0.0089xt), r2 > 0.999. There was no correlation between Vsevo and
patient characteristics, except that Vsevo was greater in patients with a
greater cardiac output (r2 = 0.36) and cardiac index (r2 = 0.35). The rate
of sevoflurane uptake decreased less than predicted by the square root of
time and four-compartment models, even when measured cardiac output was
used in the formulae. These findings confirm that the square root of time
and four-compartment models do not accurately predict anaesthetic uptake.
In addition, uptake of sevoflurane cannot be predicted by patient
characteristics but was higher in patients with a higher cardiac output.
CLINICAL INVESTIGATIONS
Sevoflurane pharmacokinetics: effect of cardiac output
Department of Anaesthesiology, Intensive Care and Pain Therapy, Catharina Hospital, Eindhoven, The Netherlands; Department of Anesthesiology, Northwestern University Medical School, 303 E. Superior St., Suite 360, Chicago, IL 60611-3053, USA
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