Time to Peak Concentration of Amikacin in the Antebrachiocarpal Joint Following Cephalic Intravenous Regional Limb Perfusion in Standing Horses

摘要

Objective?The aim of this study was to determine the time (T_(max)) to the maximum concentration (C_(max)) of amikacin sulphate in synovial fluid of the radiocarpal joint (RCJ) following cephalic intravenous regional limb perfusion (IVRLP) using 2?g of amikacin sulphate. Methods?Cephalic IVRLP was performed with 2?g of amikacin sulphate diluted in 0.9% NaCl to a total volume of 100?mL in six healthy adult mixed breed mares. An Esmarch's rubber tourniquet was applied for 30?minutes and the antibiotic solution was infused through a 23-gauge butterfly catheter. Synovial fluid was collected from the RCJ prior to the infusion and at 5, 10, 15, 20, 25 and 30?minutes after completion of IVRLP. The tourniquet was removed after the last arthrocentesis. Synovial fluid amikacin sulphate concentrations were determined by liquid chromatography/tandem mass spectrometry. Results?The calculated mean T_(max) occurred at 15?minutes (range: 10–20?minutes) post-perfusion. The highest synovial fluid amikacin sulphate concentration was noted at 10?minutes in 2 horses, 15?minutes in 2 horses and 20?minutes in 2 horses. The highest mean concentration was 1023 μg/mL and was noted at 20?minutes. Synovial mean concentrations were significantly different between 15 and 30?minutes. Clinical Significance?In this study no T_(max) occurred after 20?minutes; thus, 30?minutes of tourniquet application time appear to be excessive. The 20?minutes duration of tourniquet application appears sufficient for the treatment of the RCJ in cephalic IVRLP using 2?g amikacin sulphate in a total volume of 100?mL.