Pharmacokinetics of sufentanil in patients undergoing coronary artery bypass graft surgery.
OBJECTIVE
To determine the pharmacokinetics of sufentanil in patients undergoing coronary artery bypass graft surgery.


METHODS
Prospective, multigroup study.


METHODS
University-affiliated hospital.


METHODS
Patients with good left ventricular function undergoing elective surgery (n = 103).


METHODS
Sufentanil was administered by target-controlled infusion, with target effect-site concentrations ranging from 0.4 to 4.5 ng/mL. Isoflurane was administered as required to maintain stable hemodynamics. Sufentanil pharmacokinetics were determined by population modeling. The potential effects of gender, weight, different premedications (lorazepam, morphine-scopolamine, or clonidine), and coinduction with propofol on sufentanil pharmacokinetics were explored.


RESULTS
The first model determined was a simple 3-compartment model, without any covariates, which had these parameters: V(1) = 5.7 L, V(2) = 18.1 L, V(3) = 225 L, Cl(1) = 0.69 L/min, Cl(2) = 3.1 L/min, and Cl(3) = 1.4 L/min. The overall predictive ability during the entire pre-cardiopulmonary bypass period of this model was excellent, with virtually no bias (median prediction error, -0.4%) and good precision (median absolute prediction error, 18.4%). More complex models with the various premedications used or coinduction with propofol as covariates did not improve the predictive accuracy or precision compared with the simple 3-compartment model. Similarly, including either gender or weight as a covariate did not improve predictive ability.


CONCLUSIONS
The authors have determined a pharmacokinetic model for sufentanil that can be used to maintain desired target concentrations of sufentanil before cardiopulmonary bypass, with a high degree of accuracy and acceptable variability. Concomitantly administered medications (lorazepam, morphine-scopolamine, clonidine, or propofol) do not appear to have any clinically important effects on distribution-phase sufentanil pharmacokinetics.
Hudson
R J
RJ
Department of Anesthesia, University of Manitoba, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Manitoba, Canada R2H 2A6. rhudson@cc.umanitoba.ca
Henderson
B T
BT
Thomson
I R
IR
Moon
M
M
Peterson
M D
MD
D000368:Aged; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011229:Preanesthetic Medication; D011446:Prospective Studies; D017409:Sufentanil / Q000494:pharmacology*
D018686:Anesthetics, Intravenous; D017409:Sufentanil