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Perioperative Cefamandolprophylaxe bei aortocoronaren Bypass-Operationen Serumkonzentrationsverlauf während der extrakorporalen Zirkulation

Perioperative cefamandole prophylaxis in aortocoronary bypass operations: Course of serum concentration during extracorporeal circulation

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Summary

Antibiotic prophylaxis with 2 g Cefamandole at induction of anaesthesia was performed in 12 male patients undergoing aortocoronary bypass surgery. Caused by hemodilution, there was a marked decrease of serum concentration at the beginning of extracorporeal circulation, from 110.96 ± 40.29 mcg/ml to 70.89 ± 34.65 mcg/ml within 10 min. During extracorporeal circulation, elimination was as fast as before and after perfusion. 240 min after application, mean serum concentrations of 16.80 ± 9.32 mcg/ml were measured. Failure of antibiotic prophylaxis in operations exceeding 4 h might be due to unadaequate antibiotic concentrations, beyond the minimal inhibitory concentration for the pathogens, reported to cause infections after cardiac operations.

Zusammenfassung

Eine perioperative antibiotische Kurzprophylaxe mit 2 g Cefamandol intravenös bei Narkoseeinleitung wurde bei 12 Patienten während coronarchirurgischer Eingriffe unter Verwendung der Herz-Lungen-Maschine durchgeführt. Bei Beginn der extrakorporalen Zirkulation (= EKZ) kam es infolge Hämodilution zu einem Absinken der Serumkonzentrationen von 110,96 ± 40,29 mcg/ml auf 70,89 ± 34,65 μg/ml innerhalb von 10 min. Im weiteren Verlauf der EKZ war der Abfall der Serumspiegel gleich schnell wie davor und danach. Nach 240 min fanden sich noch Serumspiegel von 16,80 ± 9,32 μg/ml. Als Ursache für das Versagen einer antibiotischen Prophylaxe kommt bei einer Operationsdauer von mehr als 4 h das Absinken der Serumspiegel unter die minimale Hemmkonzentration der entsprechenden Keime in Frage.

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Authors and Affiliations

  1. der Klinik für Anaesthesie und Allgemeine Intensivmedizin, Forschungsstelle für Intensivmedizin, Spitalgasse 23, A-1090, Wien

    W. Sandtner

  2. II. Chirurgische Universitäts-Klinik, Spitalgasse 23, A-1090, Wien

    W. Klepetko & J. Miholic

  3. Klinik für Chemotherapie der Universität Wien, Spitalgasse 23, A-1090, Wien

    A. Georgopoulos & W. Graninger

Authors
  1. W. Klepetko
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  2. A. Georgopoulos
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  3. W. Graninger
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  4. J. Miholic
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  5. W. Sandtner
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Klepetko, W., Georgopoulos, A., Graninger, W. et al. Perioperative Cefamandolprophylaxe bei aortocoronaren Bypass-Operationen Serumkonzentrationsverlauf während der extrakorporalen Zirkulation. Langenbecks Arch Chiv 362, 237–243 (1984). https://doi.org/10.1007/BF01254650

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  • DOI: https://doi.org/10.1007/BF01254650

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