Case Reports: Case Report
Those of us enamored of theories describing the pharmacokinetics of inhaled anesthetics are wedded to cartoons of what underlies the uptake and distribution of these and (the larger picture) other lipophilic drugs that make up so much of the anesthetist’s armamentarium. As Price taught us,1 when we inject a lipophilic drug like thiopental IV, it first distributes to a central compartment (some call it the vessel-rich group of tissues), then redistributes to muscle, and finally to fat. Metabolism adds to the redistribution and so does intertissue diffusion. I and others have applied these images, these cartoons, to inhaled anesthetics.2
The case report by Steen et al.3 presents us with fantastical images that deviate from our commonplace notions. Steen et al.3 encountered a patient whose blood during 1 anesthetic experience was largely fat and whose fatty tissue had disappeared. Treatment restored the blood (but not the fatty tissues) to normal, no longer fatty, blood, and as fate would have it incidentally, the patient required a second anesthetic administration and the chance to see, in the same patient, the consequences of a remarkable change in blood solubility. As with other theories, it is such extremes that supply interesting challenges to or support of theories. And it is only in case reports that such opportunities arise.
Edmond I Eger II, MD
Department of Anesthesia and Perioperative Care
University of California
San Francisco, California
1. Price HL. A dynamic concept of the distribution of thiopental in the human body. Anesthesiology. 1960;21:40–5
2. Eger EI II Anesthetic Uptake and Action. 1974 Baltimore, MD Williams and Wilkins:1–371
3. Steen ER, De Baerdemaeker LEC, Van Limmen J, Wouters P. Some pharmacokinetics of sevoflurane in a child with severe lipodystrophy.