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Anaes VivasPhysiology

Anaes Vivas · Physiology

Data viva — concentration-time curves and the context-sensitive half-time

A Primary data viva — read a bi-exponential concentration-time curve and derive Vd, CL and kelim; explain the alpha (distribution) and beta (elimination) phases and why recovery from a bolus is governed by redistribution; then read the context-sensitive half-time-versus-duration graph and explain why remifentanil is flat while fentanyl, thiopental and alfentanil rise, and how this guides the choice of infusion opioid.

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Prompt
Two graphs are shown. The first is a log-concentration-versus-time plot after an intravenous bolus, showing a bi-exponential decline with a steep alpha (distribution) phase and a shallow beta (elimination) phase, with the rate constants k12, k21 and k10 indicated. The second plots context-sensitive half-time (vertical, minutes) against infusion duration (horizontal, hours): a flat line at about 3 minutes labelled remifentanil, and rising curves labelled fentanyl, thiopental and alfentanil. Define Vd, CL and t1/2 from the first graph, explain the alpha and beta phases, and explain the shape of the CSHT curves.

Stimulus

Two graphs are shown. The first is a log-concentration-versus-time plot after an intravenous bolus, showing a bi-exponential decline with a steep alpha (distribution) phase and a shallow beta (elimination) phase, with the rate constants k12, k21 and k10 indicated. The second plots context-sensitive half-time (vertical, minutes) against infusion duration (horizontal, hours): a flat line at about 3 minutes labelled remifentanil, and rising curves labelled fentanyl, thiopental and alfentanil. Define Vd, CL and t1/2 from the first graph, explain the alpha and beta phases, and explain the shape of the CSHT curves.

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References6ShowHide
  1. [6]Hughes MA, Glass PSA, Jacobs JR. Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology, 1992.PMID 1539843
  2. [8]Kapila A, Glass PS, Jacobs JR, et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology, 1995.PMID 7486182
  3. [7]Egan TD, et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers. Anesthesiology, 1993.PMID 7902032
  4. [2]Rowland M, Benet LZ, Graham GG. Clearance concepts in pharmacokinetics. Journal of Pharmacokinetics and Biopharmaceutics, 1973.PMID 4764426
  5. [1]Wilkinson GR, Shand DG. Commentary: a physiological approach to hepatic drug clearance. Clinical Pharmacology and Therapeutics, 1975.PMID 1164821
  6. [9]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
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