[Pharmacology in critical illness]

Patients suffering from critical illnesses like cardiac arrest with resuscitation and hypovolemic shock often are in need of medication. Under these conditions pharmacokinetics and pharmacodynamics can be markedly altered. In this paper the results of our experimental work in animals on the pharmacology during resuscitation and hypovolemia is discussed. The data show that during cardiopulmonary resuscitation in the dog the kinetics of epinephrine are changed. The administration of the calcium antagonist nimodipine does not result in a cerebroprotective action in a cardiopulmonary arrest model in the rat. The pharmacokinetics and pharmacodynamics of the anesthetics etomidate and propofol were studied in a model of hemorrhagic hypovolemia in the rat. Changes in plasma concentrations as well as in brain sensitivity occur. It is concluded that animal experiments highlight changes in the action of drugs during critical conditions. Such information can be helpful in view of the practical and ethical problems related to the study of the action of drugs in critically ill patients.