OBJECTIVE: To determine the effect of intraoperative blood loss on prophylactic cefazolin and gentamicin serum and tissue concentrations. DESIGN: A prospective study of elective spinal instrumentation surgical procedures with an expected large blood loss. SETTING: Tertiary care, inner-city university hospital. PATIENTS: Eleven adult patients who underwent an elective surgical procedure that involved spinal instrumentation. INTERVENTION: Standard perioperative administration of a combination of cefazolin and gentamicin. Serum and tissue samples were obtained consecutively throughout the surgical procedure. MAIN OUTCOME MEASURES: The effect of intraoperative blood loss on serum and tissue cefazolin and gentamicin concentrations and their pharmacokinetics. RESULTS: At the time of the incision, serum cefazolin concentrations were greater than tissue concentrations (P = .07). A mean dose of 1.8-mg/kg gentamicin yielded low or nontherapeutic serum and tissue gentamicin concentrations. Cefazolin and gentamicin were eliminated from the tissue compartment slower than from the serum compartment (P < .03), while the half-life of cefazolin was significantly (P = .06) longer in the tissue compartment. The volume of distribution of cefazolin was normal (ie, 12.5 L), while the volume of distribution of gentamicin was 5-fold greater than expected. At 60 minutes after the incision, blood loss correlated with cefazolin tissue concentrations (r = -0.66, P = .05). Blood loss correlated with the change in tissue antibiotic concentrations for cefazolin (r = 0.73, P = .04). In addition, the clearance of gentamicin from the tissues correlated with blood loss (r = 0.82, P = .01). CONCLUSIONS: Based on measured pharmacokinetic values, additional doses of cefazolin should be administered when the operation exceeds 3 hours and blood loss is greater than 1500 mL. Doses of gentamicin greater than 1.8 mg/kg should be administered more than 30 minutes prior to the surgical incision.
OBJECTIVE: To determine the effect of intraoperative blood loss on prophylactic cefazolin and gentamicin serum and tissue concentrations. DESIGN: A prospective study of elective spinal instrumentation surgical procedures with an expected large blood loss. SETTING: Tertiary care, inner-city university hospital. PATIENTS: Eleven adult patients who underwent an elective surgical procedure that involved spinal instrumentation. INTERVENTION: Standard perioperative administration of a combination of cefazolin and gentamicin. Serum and tissue samples were obtained consecutively throughout the surgical procedure. MAIN OUTCOME MEASURES: The effect of intraoperative blood loss on serum and tissue cefazolin and gentamicin concentrations and their pharmacokinetics. RESULTS: At the time of the incision, serum cefazolin concentrations were greater than tissue concentrations (P = .07). A mean dose of 1.8-mg/kg gentamicin yielded low or nontherapeutic serum and tissue gentamicin concentrations. Cefazolin and gentamicin were eliminated from the tissue compartment slower than from the serum compartment (P < .03), while the half-life of cefazolin was significantly (P = .06) longer in the tissue compartment. The volume of distribution of cefazolin was normal (ie, 12.5 L), while the volume of distribution of gentamicin was 5-fold greater than expected. At 60 minutes after the incision, blood loss correlated with cefazolin tissue concentrations (r = -0.66, P = .05). Blood loss correlated with the change in tissue antibiotic concentrations for cefazolin (r = 0.73, P = .04). In addition, the clearance of gentamicin from the tissues correlated with blood loss (r = 0.82, P = .01). CONCLUSIONS: Based on measured pharmacokinetic values, additional doses of cefazolin should be administered when the operation exceeds 3 hours and blood loss is greater than 1500 mL. Doses of gentamicin greater than 1.8 mg/kg should be administered more than 30 minutes prior to the surgical incision.
Authors: Simone van Kralingen; Margot Taks; Jeroen Diepstraten; Ewoudt M van de Garde; Eric P van Dongen; Marinus J Wiezer; Bert van Ramshorst; Bart Vlaminckx; Vera H Deneer; Catherijne A Knibbe Journal: Eur J Clin Pharmacol Date: 2011-04-16 Impact factor: 2.953
Authors: Teena Chopra; Jing J Zhao; George Alangaden; Michael H Wood; Keith S Kaye Journal: Expert Rev Pharmacoecon Outcomes Res Date: 2010-06 Impact factor: 2.217
Authors: T Kosaka; K Hosokawa; N Shime; F Taniguchi; T Kokufu; S Hashimoto; H Fujiwara; H Yaku; N Sugioka; K Okada; N Fujita Journal: Eur J Clin Microbiol Infect Dis Date: 2011-05-20 Impact factor: 3.267
Authors: A S Himebauch; W N Sankar; J M Flynn; M T Sisko; G S Moorthy; J S Gerber; A F Zuppa; E Fox; J P Dormans; T J Kilbaugh Journal: Br J Anaesth Date: 2016-07 Impact factor: 9.166