Anesthesiology

Download Anesthesia [2 vols] by R. Miller PDF

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By R. Miller

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Extra resources for Anesthesia [2 vols]

Sample text

If the liver could extract all the drug from the afferent flow, then clearance would equal Q. However, the liver cannot remove all the drug; there is always some drug in the effluent plasma. The fraction of inflowing drug extracted by the liver is . This is called the extraction ratio. Clearance is the amount of blood completely cleared of drug per unit time. We can calculate clearance as Q times the extraction ratio: With this basic understanding of clearance, let us divide each part of equation 4 by C inflow : 20 Figure 2-6 (Figure Not Available) The relationship between concentration, expressed in units of K m (Michaelis constant), and the rate of drug metabolism, in units of V m (maximum rate).

One consequence of the putative adverse fetal effects was the initiation of epidemiologic studies that purported to show that the pregnant woman involved in operating room activities (nurses, anesthesiologists, and wives of anesthesiologists) could be exposed to trace anesthetic gases. A higher incidence of fetal loss was claimed, which led to the expensive installation of scavenging systems and the revival of closed-system anesthesia techniques with all of their complexities (Chs. 6 and 84) . The development of contemporary anesthesia can be embellished by citing the improvement in anesthetic apparatus and monitoring systems toward greater safety or, on the pharmacologic side, continued search for the basis of narcosis at the molecular level.

Figure 2-1 shows the dilution of administered drug into a tank of fluid. By definition, the concentration in the tank is the amount of drug administered divided by the volume of the tank. If we do not know the volume beforehand, but can measure the concentration, then we can rearrange the definition of concentration to tell us the volume of the tank: Once the volume of the tank is known, the concentration following any bolus of drug can be calculated as the dose/volume. Just as the tank has a volume whether or not there is drug in it, the volume of distribution of a particular drug is an intrinsic property of the individual, whether or not any drug has been given.

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