C.-A. Ewaldsson, R.G. Hahn British Journal of Anaesthesia

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Volume kinetics of Ringer's solution during induction of spinal and general anaesthesia C.-A. Ewaldsson, R.G. Hahn British Journal of Anaesthesia Volume 87, Issue 3, Pages 406-414 (September 2001) DOI: 10.1093/bja/87.3.406 Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 1 Schematic drawing of the one-volume kinetic model (top) and the two-volume kinetic model (bottom) used to calculate the size of the body fluid space expanded by i.v. infusion of fluid in humans. British Journal of Anaesthesia 2001 87, 406-414DOI: (10.1093/bja/87.3.406) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 2 Dilution-time profiles in individual patients (thin lines) and the modelled dilution based on the mean parameter estimates shown in Table 2 (circles) during a continuous-rate infusion of Ringer's solution during which spinal anaesthesia (subplots a and b) or general anasthesia (subplots c and d) was induced after 20 min. The one-volume space model was applied to the data in subplots a and c (closed circles=dilution of V). The two-volume space model was applied to the data in subplots b and d (closed circles=dilution of V1, open circles=dilution of V2). British Journal of Anaesthesia 2001 87, 406-414DOI: (10.1093/bja/87.3.406) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 3 MAP (top) and heart rate (middle) when spinal or general anaesthesia was induced after 20 min of a continuous-rate infusion of 20 ml kg−1 of Ringer's acetate solution. The relative changes in MAP are also shown (bottom). British Journal of Anaesthesia 2001 87, 406-414DOI: (10.1093/bja/87.3.406) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 4 Relationships between the change in MAP during the induction of anaesthesia and the size of V after it had been induced in the eight patients in whom the one-volume model was statistically justified (left), to kt after the induction (two-volume model, middle, one extreme outlier omitted) and to the difference in kt from before to after the induction (two-volume model, right). The change in MAP was obtained as the mean of all measurements noted between 0 and 18 min divided by the mean obtained between 27 and 60 min of the study. British Journal of Anaesthesia 2001 87, 406-414DOI: (10.1093/bja/87.3.406) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 5 Computer simulations showing left: the excess volume in V1 before and after the induction of anaesthesia in a subject with a body weight of 75 kg who received an i.v. infusion of 25 ml min−1 of Ringer's acetate solution. The increment between the solid lines represents, with a 50% probability, the increment in volume resulting from the anaesthesia. (Right) The infusion rates (ml min−1) required to obtain, within only 2 min, a predetermined volume increase in V1 during the onset of anaesthesia. The numbers to the right show the infusion rates required to maintain the volume increase obtained with the first more rapid infusion. Here, the initial phase of volume loading shown in the figure to the left has been omitted. British Journal of Anaesthesia 2001 87, 406-414DOI: (10.1093/bja/87.3.406) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 6 Computer simulations showing the predicted dilution of V1 (left) and the excess volume in V1 (middle) and in V2 (right) when Ringer's acetate solution was infused at a rate of 5, 10, 15, 20, 25, and 30 ml kg−1 per 60 min in a subject with a body weight of 75 kg. The upper row shows the situation when anaesthesia was induced after 20 min and the lower one when it was postponed until 40 min. All curves are based on the mean parameter estimates obtained for the 12 infusions for which the two-volume model was applied. British Journal of Anaesthesia 2001 87, 406-414DOI: (10.1093/bja/87.3.406) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions

Fig 7 Spinal hypotension when i.v. fluid is given at different rates. (Top) The relative change in MAP in patients receiving spinal anaesthesia at 20 min. The first group (‘slow infusion’, n=10) were given 20 ml kg−1 of Ringer's acetate as a continuous infusion over 60 min, and the others (‘rapid infusion’, n=5) had their entire preload given between 20 and 22 min. (Bottom) The dilution-time profiles of the rapid infusion group and the modelled curve (dark triangles) based on the mean values of the volume kinetic parameters. British Journal of Anaesthesia 2001 87, 406-414DOI: (10.1093/bja/87.3.406) Copyright © 2001 British Journal of Anaesthesia Terms and Conditions