Pharmacokinetics of analgesics, sedatives and anaesthetic agents during cardiopulmonary bypass

Gedney, J.; Ghosh, Sudipta

doi:10.1093/bja/75.3.344

Cited by 33 publications

(19 citation statements)

References 63 publications

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“…This is due to altered distribution volumes (secondary to priming of the ECC), acid-base, organ blood flow, plasma protein concentration and body temperature alterations (Gedney & Ghosh 1995). Particularly fentanyl pharmacokinetics are altered during ECC (more so than those for remifentanil; Russel et al 1997).…”

Section: Laboratory Animals (2005) 39mentioning

confidence: 99%

Prolonged recovery and respiratory depression after fentanyl infusion in a sheep undergoing mitral valve reconstruction

et al. 2005

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SummaryA sheep was anaesthetized for implantation of a novel device (MitroFast s ) to replace the posterior leaflet of the mitral valve. Anaesthetic management included a balanced anaesthetic protocol and consisted of propofol or isoflurane combined with fentanyl infusion (0.15-0.4 mg/kg/min). Deliberate hypothermia during cardiopulmonary bypass was set at 34.5-35.51C. Surgery proceeded uneventfully. Total time of aortic cross-clamping was 35 min and total time on extracorporeal circulation was 60 min. Visual inspection, intracardiac pressure testing and transesophageal echocardiography indicated proper functioning of the device. The anaesthetic period was uneventful, but recovery was prolonged with central nervous and respiratory depression and marked hypoxaemia. Administration of naloxone (1.5 mg/kg, repeated twice at 15-20 min intervals) reversed the central nervous and attenuated the respiratory depressions. An initially low rate of urine production normalized after rewarming and a single intravenous administration of furosemide.

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Section: Laboratory Animals (2005) 39mentioning

confidence: 99%

Prolonged recovery and respiratory depression after fentanyl infusion in a sheep undergoing mitral valve reconstruction

et al. 2005

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“…When administered by constant infusion, the plasma concentration of fentanyl decreased (average 30%) on commencing bypass, and then returned to pre‐bypass levels within 30 min . No relationship between temperature and fentanyl concentration has been observed . The total concentration of alfentanil decreased by 60% with the onset of bypass during a constant infusion, and the authors suggested that this could be attributed to haemodilution .…”

Section: Discussionmentioning

confidence: 99%

Performance of the Minto model for the target‐controlled infusion of remifentanil during cardiopulmonary bypass

Cho

et al. 2017

Anaesthesia

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We studied the predictive performance of the Minto pharmacokinetic model during cardiopulmonary bypass in patients undergoing cardiac surgery. Patients received remifentanil target-controlled infusion using the Minto model during total intravenous anaesthesia with propofol. From 56 patients, 275 arterial blood samples were drawn before, during and after bypass to determine the plasma concentration of remifentanil, and the predicted concentrations were recorded at each time. For pooled data, the median prediction error and median absolute prediction error were 21.3% and 21.8%, respectively, and 22.1% and 22.3% during bypass. Both were 148.4% during hypothermic circulatory arrest and measured concentrations were more than three times greater than predicted (26.9 (17.0) vs. 7.1 (1.6) ng.ml ). The Minto model showed considerable bias but overall acceptable precision during bypass. The target concentration of remifentanil should be reduced when using the Minto model during hypothermic circulatory arrest.

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“…under conditions of cardiopulmonary bypass (CPB), hypothermia, haemodilution, etc. have been well described during previous decades but appear hardly relevant to the drug's current spectrum of use …”

Section: Etomidate Use In Specific Clinical Situationsmentioning

confidence: 99%

Etomidate - a review of robust evidence for its use in various clinical scenarios

Erdoes

Basciani

Eberle

2014

Acta Anaesthesiol Scand

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Etomidate is an intravenous hypnotic with a favourable clinical profile in haemodynamic high-risk scenarios. Currently, there is an active debate about the clinical significance of the drug's side effects and its overall risk-benefit ratio. Etomidate-induced transient adrenocortical suppression is well documented and has been associated with increased mortality in sepsis. In surgical patients at risk of hypotensive complications, however, a review of current literature provides no robust evidence to contraindicate a single-bolus etomidate induction. Large randomised controlled trials as well as additional observational data are required to compare safety of etomidate and its alternatives.

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Pharmacokinetics of analgesics, sedatives and anaesthetic agents during cardiopulmonary bypass

Cited by 33 publications

References 63 publications

Prolonged recovery and respiratory depression after fentanyl infusion in a sheep undergoing mitral valve reconstruction

Prolonged recovery and respiratory depression after fentanyl infusion in a sheep undergoing mitral valve reconstruction

Performance of the Minto model for the target‐controlled infusion of remifentanil during cardiopulmonary bypass

Etomidate - a review of robust evidence for its use in various clinical scenarios

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