The Effect of Modified Ultrafiltration on Serum Vancomycin Levels During Cardiopulmonary Bypass in Cardiac Surgery

Crimi, Ettore; Hernandez-Barajas, Daniel; Seller, Aaron; Ashton, Jennifer N.; Martin, M; Vasilopoulos, Terrie; Gravenstein, Nikolaus

doi:10.1053/j.jvca.2018.06.004

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…An increase or decrease in concentration post-MUF depends on the volume of the distribution, plasma protein binding, filtration rate, and volume as well as the type of filter membrane. 23,24 Other highly protein-bound drugs such as fentanyl were known to increase post-MUF. 25 An increase in the concentration of DEX post-MUF is consistent with its high plasma protein binding of 94% and volume of distribution of 90–194 L. 26 The results from the current study at therapeutically relevant concentrations add important knowledge to DEX CPB therapy.…”

Section: Discussionmentioning

confidence: 99%

Sequestration of Dexmedetomidine in Ex Vivo Cardiopulmonary Bypass Circuits

Wilder

Andropoulos

Paugh³

et al. 2021

ASAIO Journal

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Dexmedetomidine (DEX) is a sedative used in combination with other drugs in neonates and infants undergoing cardiac surgery using cardiopulmonary bypass (CPB). This study aimed to evaluate the disposition of DEX after administration to the ex vivo CPB circuits following different bolus doses and continuous infusion of DEX, including the effect of circuit coating, temperature, and modified ultrafiltration (MUF). Cardiopulmonary bypass circuits were setup ex vivo and primed with reconstituted blood. Dexmedetomidine was administered to the circuit (as a single bolus or single bolus along with continuous infusion). The circuit was allowed to equilibrate during the first 5 minutes, blood samples were collected at multiple time points (5–240 minutes). Blood samples were processed to collect plasma and analyzed for DEX with a validated assay. The majority of DEX sequestration in ex vivo CPB circuits occurred within the first 15 minutes. The percent of DEX remained in plasma pre-MUF (16–71%) and post-MUF (22–92%) varied depending on the dose and dosing scheme. Modified ultrafiltration significantly increased the plasma concentration of DEX in 19 of 23 circuits by an average of 12.1 ± 4.25% (p < 0.05). The percent sequestration of DEX was lower in CPB circuits at lower DEX doses compared to higher doses. A combination of DEX initial loading dose and continuous infusion resulted in steady concentrations of DEX over 4 hours. At therapeutically relevant concentrations of DEX (485–1,013 pg/ml), lower sequestration was observed in ex vivo CPB circuits compared to higher doses. The sequestration of DEX to circuits should be considered to achieve the optimal concentration of DEX during CPB surgery.

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Section: Discussionmentioning

confidence: 99%

Sequestration of Dexmedetomidine in Ex Vivo Cardiopulmonary Bypass Circuits

Wilder

Andropoulos

Paugh³

et al. 2021

ASAIO Journal

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“…44 Furthermore, the use of intraoperative ultrafiltration can potentially decrease antibiotic serum levels. 45 In case of uncertainty on adequate dosing, an infectious diseases specialist and/or pharmacist should be consulted. Perioperative management of antibiotic therapy in infective endocarditis is thus still a field of uncertainties, in which further research is warranted.…”

Section: Considerations Regarding Specific Pathogens and Antibioticsmentioning

confidence: 99%

Anesthesia Considerations in Infective Endocarditis

et al. 2022

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The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.

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The Effect of Modified Ultrafiltration on Serum Vancomycin Levels During Cardiopulmonary Bypass in Cardiac Surgery

Cited by 2 publications

References 21 publications

Sequestration of Dexmedetomidine in Ex Vivo Cardiopulmonary Bypass Circuits

Sequestration of Dexmedetomidine in Ex Vivo Cardiopulmonary Bypass Circuits

Anesthesia Considerations in Infective Endocarditis

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