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van Haren JS, van der Hout-van der Jagt MB, Meijer N, Monincx M, Delbressine FLM, Griffith XLG, Oei SG. Simulation-based development: shaping clinical procedures for extra-uterine life support technology. Adv Simul (Lond) 2023; 8:29. [PMID: 38042828 PMCID: PMC10693037 DOI: 10.1186/s41077-023-00267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/26/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Research into Artificial Placenta and Artificial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and integrate the user perspectives in the early design phase of a protocol for this novel procedure. METHODS Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards. RESULTS Physical simulation with the active participation of clinicians led to the diffusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments. CONCLUSION This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professionals.
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Affiliation(s)
- J S van Haren
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands.
| | - M B van der Hout-van der Jagt
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - N Meijer
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - M Monincx
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - F L M Delbressine
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - X L G Griffith
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - S G Oei
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Wanat K. Biological barriers, and the influence of protein binding on the passage of drugs across them. Mol Biol Rep 2020; 47:3221-3231. [PMID: 32140957 DOI: 10.1007/s11033-020-05361-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/27/2020] [Indexed: 01/11/2023]
Abstract
Drug-protein binding plays a key role in determining the pharmacokinetics of a drug. The distribution and protein binding ability of a drug changes over a lifetime, and are important considerations during pregnancy and lactation. Although proteins are a significant fraction in plasma composition, they also exist beyond the bloodstream and bind with drugs in the skin, tissues or organs. Protein binding influences the bioavailability and distribution of active compounds, and is a limiting factor in the passage of drugs across biological membranes and barriers: drugs are often unable to cross membranes mainly due to the high molecular mass of the drug-protein complex, thus resulting in the accumulation of the active compounds and a significant reduction of their pharmacological activity. This review describes the consequences of drug-protein binding on drug transport across physiological barriers, whose role is to allow the passage of essential substances-such as nutrients or oxygen, but not of xenobiotics. The placental barrier regulates passage of xenobiotics into a fetus and protects the unborn organism. The blood-brain barrier is the most important barrier in the entire organism and the skin separates the human body from the environment.
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Affiliation(s)
- Karolina Wanat
- Department of Analytical Chemistry, Medical University of Lodz, Muszyńskiego 1, 90-151, Lodz, Poland.
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Ngamprasertwong P, Dong M, Niu J, Venkatasubramanian R, Vinks AA, Sadhasivam S. Propofol Pharmacokinetics and Estimation of Fetal Propofol Exposure during Mid-Gestational Fetal Surgery: A Maternal-Fetal Sheep Model. PLoS One 2016; 11:e0146563. [PMID: 26752560 PMCID: PMC4713870 DOI: 10.1371/journal.pone.0146563] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Measuring fetal drug concentrations is extremely difficult in humans. We conducted a study in pregnant sheep to simultaneously describe maternal and fetal concentrations of propofol, a common intravenous anesthetic agent used in humans. Compared to inhalational anesthesia, propofol supplemented anesthesia lowered the dose of desflurane required to provide adequate uterine relaxation during open fetal surgery. This resulted in better intraoperative fetal cardiac outcome. This study describes maternal and fetal propofol pharmacokinetics (PK) using a chronically instrumented maternal-fetal sheep model. METHODS Fetal and maternal blood samples were simultaneously collected from eight mid-gestational pregnant ewes during general anesthesia with propofol, remifentanil and desflurane. Nonlinear mixed-effects modeling was performed by using NONMEM software. Total body weight, gestational age and hemodynamic parameters were tested in the covariate analysis. The final model was validated by bootstrapping and visual predictive check. RESULTS A total of 160 propofol samples were collected. A 2-compartment maternal PK model with a third fetal compartment appropriately described the data. Mean population parameter estimates for maternal propofol clearance and central volume of distribution were 4.17 L/min and 37.7 L, respectively, in a typical ewe with a median heart rate of 135 beats/min. Increase in maternal heart rate significantly correlated with increase in propofol clearance. The estimated population maternal-fetal inter-compartment clearance was 0.0138 L/min and the volume of distribution of propofol in the fetus was 0.144 L. Fetal propofol clearance was found to be almost negligible compared to maternal clearance and could not be robustly estimated. CONCLUSIONS For the first time, a maternal-fetal PK model of propofol in pregnant ewes was successfully developed. This study narrows the gap in our knowledge in maternal-fetal PK model in human. Our study confirms that maternal heart rate has an important influence on the pharmacokinetics of propofol during pregnancy. Much lower propofol concentration in the fetus compared to maternal concentrations explain limited placental transfer in in-vivo paired model, and less direct fetal cardiac depression we observed earlier with propofol supplemented inhalational anesthesia compared to higher dose inhalational anesthesia in humans and sheep.
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Affiliation(s)
- Pornswan Ngamprasertwong
- Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- * E-mail:
| | - Min Dong
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Jing Niu
- Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- Department of Anesthesia, Shanghai Children’s Medical Center, Shanghai, China
| | - Raja Venkatasubramanian
- Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Alexander A. Vinks
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Senthilkumar Sadhasivam
- Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
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Ueki R, Tatara T, Kariya N, Shimode N, Hirose M, Tashiro C. Effect of decreased fetal perfusion on placental clearance of volatile anesthetics in a dual perfused human placental cotyledon model. J Anesth 2014; 28:635-8. [PMID: 24384731 DOI: 10.1007/s00540-013-1777-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
Placental transfer of volatile anesthetics is a critical issue in managing fetal distress during cesarean section under general anesthesia. Using dual perfused human placental cotyledons obtained from parturients undergoing elective cesarean section (n = 5), we investigated the effect of decreased fetal perfusion on placental clearance of sevoflurane and isoflurane. Keeping the maternal flow rate fixed, fetal flow rate was consecutively decreased from 3 ml/min (control perfusion) to 2 ml/min (intermediate perfusion) and to 1 ml/min (hypoperfusion). Placental transfer was assessed by the clearance of anesthetics by the placenta, defined by the ratio of anesthetic concentration in fetal vein and maternal artery, multiplied by fetal flow rate. Placental clearance was compared between different fetal perfusion states and anesthetics. Hypoperfusion resulted in a lower clearance of sevoflurane and isoflurane compared with control (P = 0.002, P < 0.001) and intermediate (P = 0.04, P = 0.018) perfusion. Clearances of sevoflurane and isoflurane were comparable during control perfusion (P = 0.93), intermediate perfusion (P = 1.00), and hypoperfusion (P = 0.88). Thus, maintenance of volatile anesthetics at a marginally low concentration may not be necessary when fetal distress is observed during emergency cesarean delivery because placental transfer of volatile anesthetics decreases with decreasing fetal perfusion.
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Affiliation(s)
- Ryusuke Ueki
- Department of Anesthesiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan,
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Benveniste H, Fowler JS, Rooney WD, Scharf BA, Backus WW, Izrailtyan I, Knudsen GM, Hasselbalch SG, Volkow ND. Cocaine is pharmacologically active in the nonhuman primate fetal brain. Proc Natl Acad Sci U S A 2010; 107:1582-7. [PMID: 20080687 PMCID: PMC2824386 DOI: 10.1073/pnas.0909585107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cocaine use during pregnancy is deleterious to the newborn child, in part via its disruption of placental blood flow. However, the extent to which cocaine can affect the function of the fetal primate brain is still an unresolved question. Here we used PET and MRI and show that in third-trimester pregnant nonhuman primates, cocaine at doses typically used by drug abusers significantly increased brain glucose metabolism to the same extent in the mother as in the fetus (approximately 100%). Inasmuch as brain glucose metabolism is a sensitive marker of brain function, the current findings provide evidence that cocaine use by a pregnant mother will also affect the function of the fetal brain. We are also unique in showing that cocaine's effects in brain glucose metabolism differed in pregnant (increased) and nonpregnant (decreased) animals, which suggests that the psychoactive effects of cocaine are influenced by the state of pregnancy. Our findings have clinical implications because they imply that the adverse effects of prenatal cocaine exposure to the newborn child include not only cocaine's deleterious effects to the placental circulation, but also cocaine's direct pharmacological effect to the developing fetal brain.
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Affiliation(s)
- Helene Benveniste
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794, USA.
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Comparison of placental transfer of local anesthetics in perfusates with different pH values in a human cotyledon model. J Anesth 2009; 23:526-9. [DOI: 10.1007/s00540-009-0815-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
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Giaginis C, Zira A, Theocharis S, Tsantili-Kakoulidou A. Application of quantitative structureâactivity relationships for modeling drug and chemical transport across the human placenta barrier: a multivariate data analysis approach. J Appl Toxicol 2009; 29:724-33. [DOI: 10.1002/jat.1466] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Myllynen P, Pasanen M, Vähäkangas K. The fate and effects of xenobiotics in human placenta. Expert Opin Drug Metab Toxicol 2007; 3:331-46. [PMID: 17539742 DOI: 10.1517/17425255.3.3.331] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During past decades, knowledge on placental drug metabolism and mechanisms of placental transfer has increased significantly. Most pharmaceutical drugs administered during pregnancy cross the placenta to some extent. The important properties determining the placental transfer by passive diffusion are molecular weight, pK(a), lipid solubility and protein binding. In addition to passive diffusion, compounds may cross the placenta via active transfer, facilitated diffusion, phagocytosis and pinocytosis. This review gives an update of efflux transporter proteins and xenobiotic-metabolizing enzymes that modify the fate and effects of drugs in the placenta.
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Affiliation(s)
- Päivi Myllynen
- Researcher, University of Oulu, Department of Pharmacology and Toxicology, PO Box 5000, 90014 Oulu, Finland.
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Hewitt M, Madden JC, Rowe PH, Cronin MTD. Structure-based modelling in reproductive toxicology: (Q)SARs for the placental barrier. SAR AND QSAR IN ENVIRONMENTAL RESEARCH 2007; 18:57-76. [PMID: 17365959 DOI: 10.1080/10629360601053893] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The replacement of animal testing for endpoints such as reproductive toxicity is a long-term goal. This study describes the possibilities of using simple (quantitative) structure-activity relationships ((Q)SARs) to predict whether a molecule may cross the placental membrane. The concept is straightforward, if a molecule is not able to cross the placental barrier, then it will not be a reproductive toxicant. Such a model could be placed at the start of any integrated testing strategy. To develop these models the literature was reviewed to obtain data relating to the transfer of molecules across the placenta. A reasonable number of data were obtained and are suitable for the modelling of the ability of a molecule to cross the placenta. Clearance or transfer indices data were sought due to their ability to eliminate inter-placental variation by standardising drug clearance to the reference compound antipyrine. Modelling of the permeability data indicates that (Q)SARs with reasonable statistical fit can be developed for the ability of molecules to cross the placental barrier membrane. Analysis of the models indicates that molecular size, hydrophobicity and hydrogen-bonding ability are molecular properties that may govern the ability of a molecule to cross the placental barrier.
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Affiliation(s)
- M Hewitt
- School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
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Kokate A, Li X, Jasti B. Transport of a novel anti-cancer agent, fenretinide across Caco-2 monolayers. Invest New Drugs 2006; 25:197-203. [PMID: 17146731 DOI: 10.1007/s10637-006-9026-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Abstract
Fenretinide is a synthetic retinoid with chemotherapeutic activity against various malignancies. Upon oral administration to animals, fenretinide was found to be incompletely absorbed and excreted primarily in feces. The purpose of this study was to determine the possible reasons for poor oral absorption of fenretinide using Caco-2 cell monolayers. To achieve this purpose, a solid dispersion of fenretinide with Povidone K25 was used. The apparent permeability coefficient (P(app)) of fenretinide across Caco-2 monolayers in the presence of bovine serum albumin (BSA) in the receiver was determined. Apical to basolateral (AP-BL) and basolateral to apical (BL-AP) flux studies were performed to determine the role of an efflux mechanism. In the presence of 4% BSA in the receiver, the P(app) was found to be (8.8 +/- 0.5) x 10(-8) cm/sec. The AP-BL flux increased linearly with an increase in fenretinide concentration (125-640 microM) in the presence of 4% BSA in the receiver. Efflux and paracellular pathways played an insignificant role in the permeability of fenretinide. A significant amount of drug, approximately 13-15% of the initial amount accumulated in the cell membrane. The amount of fenretinide in the donor decreased by 16% over a 3 h period. However, only 0.12% of the initial amount was found in the receiver. Also, the P(app) increased with an increase in plasma protein concentration in the receiver. On the basis of these results, the poor permeability of fenretinide can be attributed to its accumulation in the lipophilic cell membrane and poor partitioning into the receiver medium.
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Affiliation(s)
- Amit Kokate
- Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA
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Caliskan E, Kayhan Z, Tufan H. Propofol inhibits potassium chloride induced contractions of isolated human umbilical vessels. Eur J Anaesthesiol 2006; 23:411-7. [PMID: 16438770 DOI: 10.1017/s0265021505001924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2005] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE We have evaluated the effects of propofol and its relationship with K+ channels on human isolated umbilical vessels. METHODS Umbilical vessel rings were suspended in isolated organ baths containing Krebs-Ringer solution. In the first series of experiments the effect of propofol (10(-9)-10(-4) M) was examined in a concentration-dependent manner on umbilical vessels precontracted with KCl (60 mmol). In the second series, these effects were studied in the presence of tetraethylammonium. RESULTS A mild contraction was produced by low dose propofol in both precontracted umbilical artery and umbilical vein segments. 10(-4) M propofol caused significant relaxation in both umbilical artery and umbilical vein. The relaxation response was significantly reduced by the addition of 10(-1) M tetraethylammonium. CONCLUSION These results suggested that the responses of propofol on KCl-induced contractions of both umbilical artery and vein were dose dependent, and this effect involved Ca2+ activated K+ channels.
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Affiliation(s)
- E Caliskan
- Adana Teaching and Medical Research Center, Department of Anaesthesiology, Baskent University, Faculty of Medicine, Adana, Turkey.
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Heikkine T, Ekblad U, Laine K. Transplacental transfer of citalopram, fluoxetine and their primary demethylated metabolites in isolated perfused human placenta. BJOG 2002; 109:1003-8. [PMID: 12269673 DOI: 10.1111/j.1471-0528.2002.01467.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the transplacental transfer and the effects of protein binding on the transfer of citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine in the isolated perfused human placenta model. DESIGN Prospective observational study. METHODS Fifteen term human placentas were obtained immediately after delivery with maternal consent and a 2-hour non-recirculating perfusion cycle of a single placental cotyledon was set up. Citalopram (1230 nmol/L) and desmethylcitalopram (600 nmol/L) or fluoxetine (1455 nmol/L) and desmethylfluoxetine (1525 nmol/L) were added to the maternal reservoir and their appearance to the fetal circulation was followed by repeated measurements. To investigate the effect of protein binding on the transfer of citalopram and fluoxetine, nine additional perfusions were performed without albumin in the perfusion medium. Citalopram and desmethylcitalopram concentrations were measured by reversed-phase high performance liquid chromatography. Fluoxetine and desmethylfluoxetine concentrations was measured by gas chromatography and antipyrine (used as a reference compound) concentrations spectrophotometrically. RESULTS The mean (SD) steady-state transplacental transfer (TPT(SS)%) for citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine was 9.1%, 5.6% (P = 0.017 compared with citalopram), 8.7% and 9.1%, respectively, calculated as the ratio between the steady-state concentrations in fetal venous and maternal arterial sides. The TPT(SS)%s of citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine were 86%, 50%, 88% and 91% of that of freely diffusable antipyrine. The absence of albumin significantly reduced the transfer of citalopram and fluoxetine (TPT(SS)% 1.1% and 4.8%, respectively) but not the transfer of antipyrine. CONCLUSION Citalopram, fluoxetine and desmethylfluoxetine all cross the human placenta, and may, therefore, affect the perinatal outcome of infants exposed to these drugs during pregnancy. The transfer of desmethylcitalopram was significantly lower, which in the clinical setting may suggest lower fetal exposure of serotonin re-uptake inhibition by citalopram compared with fluoxetine. The presence of albumin was necessary for the transplacental transfer of both citalopram and fluoxetine.
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Affiliation(s)
- Tuija Heikkine
- Department of Pharmacology and Clinical Pharmacology, University of Turku, Finland
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He YL, Seno H, Sasaki K, Tashiro C. The influences of maternal albumin concentrations on the placental transfer of propofol in human dually perfused cotyledon in vitro. Anesth Analg 2002; 94:1312-4, table of contents. [PMID: 11973210 DOI: 10.1097/00000539-200205000-00048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPLICATIONS These results indicate that fetal exposure to propofol can vary considerably depending on maternal plasma albumin concentration. A fractional change in the maternal protein binding of propofol can result in a relatively large difference in fetal exposure.
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Affiliation(s)
- Yan-Ling He
- Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya City, Japan.
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He YL, Seno H, Tsujimoto S, Tashiro C. The effects of uterine and umbilical blood flows on the transfer of propofol across the human placenta during in vitro perfusion. Anesth Analg 2001; 93:151-6. [PMID: 11429356 DOI: 10.1097/00000539-200107000-00030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The safety of using propofol in parturients is controversial, and little information is available on the factors that influence the placental transfer of propofol. In this study, we investigated the effects of uterine and umbilical blood flows on the placental transfer of propofol by using the dually perfused human placental cotyledon. Placental transfer was evaluated on the basis of the placental clearances at various uterine and umbilical flow rates. The placental transfer of propofol was significantly facilitated by the increased uterine flow rates over the range from 7.5 to 25 mL/min. The placental clearances of propofol were also dependent on the umbilical flow rates over the range from 0.5 to 4.0 mL/min. In contrast, the placental transfer of antipyrine was flow dependent when the umbilical flow rate was <2.0 mL/min and became permeability limited when it was >2.0 mL/min. No differences in either maternal or fetal venous concentrations of propofol were observed as umbilical flow rates varied from 0.5 to 4.0 mL/min, suggesting that an equilibration across the placenta occurs at low flow rates. These results indicate that fetal uptake of propofol can be profoundly altered by the changes in both uterine and umbilical blood flows observed in various pathophysiologic conditions and that lipid solubility greatly influences placental transfer of drugs. IMPLICATIONS Uterine and umbilical blood flows are determinant features in controlling the placental transfer of propofol, and, therefore, changes in these variables would significantly affect the extent of fetal exposure to propofol.
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Affiliation(s)
- Y L He
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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