| Issue |
J Extra Corpor Technol
Volume 56, Number 3, September 2024
|
|
|---|---|---|
| Page(s) | 101 - 107 | |
| DOI | https://doi.org/10.1051/ject/2024016 | |
| Published online | 20 September 2024 | |
Original Article
Extraction of ketamine and dexmedetomidine by extracorporeal life support circuits★
1
Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT 84132, USA
2
Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT 84132, USA
3
Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT 84132, USA
* Corresponding author: kevin.watt@hsc.utah.edu
Received:
11
March
2024
Accepted:
12
June
2024
Background: Patients supported with extracorporeal life support (ECLS) circuits such as ECMO and CRRT often require high doses of sedatives and analgesics, including ketamine and dexmedetomidine. Concentrations of many medications are affected by ECLS circuits through adsorption to the circuit components, dialysis, as well as the large volume of blood used to prime the circuits. However, the impact of ECLS circuits on ketamine and dexmedetomidine pharmacokinetics has not been well described. This study determined ketamine and dexmedetomidine extraction by extracorporeal circuits in an ex-vivo system. Methods: Medication was administered at therapeutic concentration to blood-primed, closed-loop ex-vivo ECMO and CRRT circuits. Drug concentrations were measured in plasma, hemofiltrate, and control samples at multiple time points throughout the experiments. At each sample time point, the percentage of drug recovery was calculated. Results: Ketamine plasma concentration in the ECMO and CRRT circuits decreased rapidly, with 43.8% recovery (SD = 0.6%) from ECMO circuits after 8 h and 3.3% (SD = 1.8%) recovery from CRRT circuits after 6 h. Dexmedetomidine was also cleared from CRRT circuits, with 20.3% recovery (SD = 1.8%) after 6 h. Concentrations of both medications were very stable in the control experiments, with approximately 100% drug recovery of both ketamine and dexmedetomidine after 6 h. Conclusion: Ketamine and dexmedetomidine concentrations are significantly affected by ECLS circuits, indicating that dosing adjustments are needed for patients supported with ECMO and CRRT.
Key words: ECMO / Pharmacology / Dialysis / Sedation / ECLS
© The Author(s), published by EDP Sciences, 2024
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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