Effect of cardiopulmonary bypass on cefazolin disposition

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Abstract
Cefazolin [antibiotic, CF] kinetics was studied in 8 patients the day before (PREOP), during (SURG) and the day after (POSTOP) cardiopulmonary bypass (CPB) surgery. PREOP (48.6 ml/min) and POSTOP (46.6 ml/min) total body clearances [TBC] were of the same order and both were greater than the SURG (27.4 ml/min) TBC. Since CF is almost entirely eliminated by the kidney, the lower SURG clearance is a result of reduced renal elimination, as confirmed by measuring CF SURG (28.7 ml/min) and POSTOP (52.9 ml/min) renal clearance. The reduction in CF renal elimination was the same throughout the surgical procedure, including the period of extracorporeal circulation. CF distribution was altered by the operative procedure as evidenced by a higher SURG steady-state volume of distribution. This increase in apparent CF distribution volume brought about by surgery was not seen with cephalothin [CP], which was investigated in a similar group of patients. The different effect of CPB surgery on CF and CP distribution may be due to differences in plasma protein binding.