Effect of haemorrhage on plasma propofol concentrations in a patient undergoing orthotopic liver transplantation

We report a patient who underwent repeat orthotopic liver transplantation c omplicated by intraoperative blood loss of more than 59 litre. During liver transplantation, a constant rate propofol infusion was given and plasma sa mples were obtained throughout the procedure for propofol assay. Before the anhepatic phase of the procedure, plasma propofol concentrations reached a plateau at I mu g ml(-1), and these concentrations were consistent with th ose predicted using a pharmacokinetic model. During the anhepatic phase of surgery, serum propofol concentrations increased progressively and exceeded those predicted by the pharmacokinetic model. Large intravascular fluid sh ifts associated with blood loss and subsequent blood replacement influenced plasma propofol concentrations observed in this patient.