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PubMed · 7578964

Anaesthesiology.

P Schoeffler·J E Bazin
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Abstract

Because of the extension of laparoscopic surgery to older patients with more complicated medical histories, anaesthetists increasingly have to face the problem of haemodynamic and respiratory tolerance of the technique. The management of such problems requires the understanding of the mechanisms involved, and their implications in terms of patient selection. Protocols where the maintenance of anaesthesia is provided using halogenated agents like isoflurane or desflurane have been shown to blunt the increase in systemic vascular resistances induced by CO2 insufflation and therefore enhance the haemodynamic tolerance of this procedure.

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Anesthesia, GeneralHemodynamicsHumansLaparoscopyLungPatient SelectionPostoperative ComplicationsJournal Article

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P Schoeffler, J E Bazin. 1995. Anaesthesiology.. https://pubmed.ncbi.nlm.nih.gov/7578964/

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Stereoselective pharmacokinetics of ketamine and norketamine after racemic ketamine or S-ketamine administration during isoflurane anaesthesia in Shetland ponies.

BACKGROUND: The arterial pharmacokinetics of ketamine and norketamine enantiomers after racemic ketamine or S-ketamine i.v. administration were evaluated in seven gelding ponies in a crossover study (2-month interval). METHODS: Anaesthesia was induced with isoflurane in oxygen via a face-mask and then maintained at each pony's individual MAC. Racemic ketamine (2.2 mg kg(-1)) or S-ketamine (1.1 mg kg(-1)) was injected in the right jugular vein. Blood samples were collected from the right carotid artery before and at 1, 2, 4, 8, 16, 32, 64, and 128 min after ketamine administration. Ketamine and norketamine enantiomer plasma concentrations were determined by capillary electrophoresis. Individual R-ketamine and S-ketamine concentration vs time curves were analysed by non-linear least square regression two-compartment model analysis using PCNonlin. Plasma disposition curves for R-norketamine and S-norketamine were described by estimating AUC, C(max), and T(max). Pulse rate (PR), respiratory rate (R(f)), tidal volume (V(T)), minute volume ventilation (V(E)), end-tidal partial pressure of carbon dioxide (PE'(CO(2))), and mean arterial blood pressure (MAP) were also evaluated. RESULTS: The pharmacokinetic parameters of S- and R-ketamine administered in the racemic mixture or S-ketamine administered separately did not differ significantly. Statistically significant higher AUC and C(max) were found for S-norketamine compared with R-norketamine in the racemic group. Overall, R(f), V(E), PE'(CO(2)), and MAP were significantly higher in the racemic group, whereas PR was higher in the S-ketamine group. CONCLUSIONS: Norketamine enantiomers showed different pharmacokinetic profiles after single i.v. administration of racemic ketamine in ponies anaesthetised with isoflurane in oxygen (1 MAC). Cardiopulmonary variables require further investigation.

Anesthesia, General↗