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Effect of Experimentally Induced Synovitis on Amikacin Concentrations after Intravenous Regional Limb Perfusion
Author(s) -
BeccarVarela Axel M.,
Epstein Kira L.,
White Catherine L.
Publication year - 2011
Publication title -
veterinary surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.652
H-Index - 79
eISSN - 1532-950X
pISSN - 0161-3499
DOI - 10.1111/j.1532-950x.2011.00875.x
Subject(s) - synovitis , medicine , tourniquet , perfusion , synovial fluid , pharmacodynamics , limb perfusion , anesthesia , amikacin , pharmacokinetics , arthritis , pathology , osteoarthritis , antibiotics , chemistry , alternative medicine , biochemistry
Objectives To determine the effects of experimentally induced synovitis of the radiocarpal joint on the intra‐articular pharmacokinetics and pharmacodynamics of amikacin after intravenous regional limb perfusion ( IVRLP ). Study Design Randomized crossover experimental design. Animals Adult horses ( n = 8). Methods Horses were randomly assigned into 2 trials: synovitis and no‐synovitis. Radiocarpal joint synovitis was induced with lipopolysaccharide 6 hours before IVRLP . IVRLP (5‐mg/kg amikacin qs 60 mL) was performed with a pneumatic tourniquet under general anesthesia. Synovial fluid was obtained before and 0.5, 1, 3, 5, 12, 24, 48 hours after IVRLP . Amikacin concentrations at each time point and pharmacokinetic values were compared between synovitis and no‐synovitis trials with S tudent's t ‐test. Results Amikacin synovial fluid concentrations indicated suspected tourniquet failure on 3 occasions (2 synovitis, 1 no‐synovitis) on 3 different horses. Data from both trials in these 3 horses were excluded from further analysis. Observed time to maximal concentration ( T max ; mean ± SD = 54 ± 13.42 min) was reached earlier in synovitis joints (5/5, 30 min) than in no‐synovitis joints (1/5, 30 min and 4/5, 1 h; P = .0476) ( P = .0161). Mean observed maximal concentration ( C max ) was higher in synovitis joints (144.48 ± 43.17 μg/mL) than in no‐synovitis joints (60.02 ± 28.81 μg/mL; P = .0301). The recommended C max : minimum inhibitory concentration ratio of 8 was achieved in 3/5 of the successfully perfused joints with induced synovitis, but this ratio was not achieved in any of the clinically normal joints. Conclusion Synovitis of the radiocarpal joint resulted in an earlier observed T max and higher observed C max of intra‐articular amikacin after IVRLP compared with normal joints.