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Evaluation of an ex-vivo neonatal extracorporeal membrane oxygenation circuit on antiepileptic drug sequestration
Perfusion ( IF 1.1 ) Pub Date : 2021-06-30 , DOI: 10.1177/02676591211028183
Shamir N Kalaria 1, 2 , Omayma A Kishk 2 , Mathangi Gopalakrishnan 1 , Dayanand N Bagdure 3
Affiliation  

Antiepileptic dosing information used to manage neonatal patients receiving extracorporeal membrane oxygenation (ECMO) is limited. The objective of this study is to quantify the extent of sequestration of various antiepileptic drugs using an ex-vivo neonatal ECMO circuit. Two neonatal closed-loop ECMO circuits were prepared using a Rotaflow centrifugal pump, custom polyvinylchloride tubing and a Quadrox-i Neonatal membrane oxygenator. After 5 minutes of circuit priming and stabilization with normal saline/albumin or expired human whole blood, single boluses of levetiracetam (200 mg), lacosamide (20 mg), and phenytoin (200 mg) were injected into the circuit. To account for spontaneous drug degradation, two polyvinylchloride beakers were filled with normal saline/albumin or expired human whole blood and equivalent antiepileptic drug doses were prepared. Simultaneous pharmacokinetic samples were collected from the control solution and the pre-centrifugal pump, pre-oxygenator, and post-oxygenator sampling ports from each circuit. Similar drug recovery profiles were observed among the three sampling sites investigated. Percent drug sequestration after a 24-hour circuit flow period was relatively similar between the two different circuits and ranged between 5.5%–13.2% for levetiracetam, 18.4%–22.3% for lacosamide, and 24.5%–30.2% for phenytoin. A comparison at 12 and 24 hours demonstrated similar percent drug sequestration across all three drugs in each circuit. Percent drug sequestrations for levetiracetam and lacosamide were less than 20% and for phenytoin were as high as 30% based on the sampling following single bolus dose administration into a neonatal ECMO circuit. Careful consideration of patient clinical status should be taken in consideration when optimizing antiepileptic therapy in neonates receiving ECMO.



中文翻译:

体外新生儿体外膜氧合回路抗癫痫药物螯合的评价

用于管理接受体外膜肺氧合 (ECMO) 的新生儿患者的抗癫痫剂量信息是有限的。本研究的目的是使用ex量化各种抗癫痫药物的螯合程度-vivo 新生儿 ECMO 电路。使用 Rotaflow 离心泵、定制聚氯乙烯管和 Quadrox-i 新生儿膜氧合器准备了两个新生儿闭环 ECMO 回路。在用生理盐水/白蛋白或过期人全血启动和稳定回路 5 分钟后,将左乙拉西坦 (200 mg)、拉考沙胺 (20 mg) 和苯妥英 (200 mg) 单次推注注射到回路中。为了解释自发药物降解,两个聚氯乙烯烧杯中装有生理盐水/白蛋白或过期的人全血,并准备了等效的抗癫痫药物剂量。同时从控制溶液和每个回路的预离心泵、预充氧器和后充氧器采样端口收集药代动力学样品。在调查的三个采样点中观察到类似的药物回收情况。24 小时回路流动期后的药物隔离百分比在两个不同回路之间相对相似,左乙拉西坦为 5.5%–13.2%,拉考沙胺为 18.4%–22.3%,苯妥英钠为 24.5%–30.2%。12 小时和 24 小时的比较表明,每个回路中所有三种药物的药物隔离百分比相似。左乙拉西坦和拉考沙胺的药物螯合百分比低于 20%,而苯妥英则高达 30%,这是基于新生儿 ECMO 回路中单次推注给药后的采样。在优化接受 ECMO 的新生儿的抗癫痫治疗时,应仔细考虑患者的临床状况。24 小时回路流动期后的药物隔离百分比在两个不同回路之间相对相似,左乙拉西坦为 5.5%–13.2%,拉考沙胺为 18.4%–22.3%,苯妥英钠为 24.5%–30.2%。12 小时和 24 小时的比较表明,每个回路中所有三种药物的药物隔离百分比相似。左乙拉西坦和拉考沙胺的药物螯合百分比低于 20%,而苯妥英则高达 30%,这是基于新生儿 ECMO 回路中单次推注给药后的采样。在优化接受 ECMO 的新生儿的抗癫痫治疗时,应仔细考虑患者的临床状况。24 小时回路流动期后的药物隔离百分比在两个不同回路之间相对相似,左乙拉西坦为 5.5%–13.2%,拉考沙胺为 18.4%–22.3%,苯妥英钠为 24.5%–30.2%。12 小时和 24 小时的比较表明,每个回路中所有三种药物的药物隔离百分比相似。左乙拉西坦和拉考沙胺的药物螯合百分比低于 20%,而苯妥英则高达 30%,这是基于新生儿 ECMO 回路中单次推注给药后的采样。在优化接受 ECMO 的新生儿的抗癫痫治疗时,应仔细考虑患者的临床状况。拉考沙胺为 3%,苯妥英为 24.5%–30.2%。12 小时和 24 小时的比较表明,每个回路中所有三种药物的药物隔离百分比相似。左乙拉西坦和拉考沙胺的药物螯合百分比低于 20%,而苯妥英则高达 30%,这是基于新生儿 ECMO 回路中单次推注给药后的采样。在优化接受 ECMO 的新生儿的抗癫痫治疗时,应仔细考虑患者的临床状况。拉考沙胺为 3%,苯妥英为 24.5%–30.2%。12 小时和 24 小时的比较表明,每个回路中所有三种药物的药物隔离百分比相似。左乙拉西坦和拉考沙胺的药物螯合百分比低于 20%,而苯妥英则高达 30%,这是基于新生儿 ECMO 回路中单次推注给药后的采样。在优化接受 ECMO 的新生儿的抗癫痫治疗时,应仔细考虑患者的临床状况。左乙拉西坦和拉考沙胺的药物螯合百分比低于 20%,而苯妥英则高达 30%,这是基于新生儿 ECMO 回路中单次推注给药后的采样。在优化接受 ECMO 的新生儿的抗癫痫治疗时,应仔细考虑患者的临床状况。左乙拉西坦和拉考沙胺的药物螯合百分比低于 20%,而苯妥英则高达 30%,这是基于新生儿 ECMO 回路中单次推注给药后的采样。在优化接受 ECMO 的新生儿的抗癫痫治疗时,应仔细考虑患者的临床状况。

更新日期:2021-07-01
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