title: Pilot study on the effect of tourniquet use on sufentanil pharmacokinetics.
abstract: OBJECTIVE
  To test our hypothesis that sequestration of sufentanil can occur during surgery when a pneumatic tourniquet is used.
  
  
  METHODS
  Prospective, randomized study.
  
  
  METHODS
  Operating room and recovery room of a university hospital.
  
  
  METHODS
  16 ASA physical status I and II patients scheduled for orthopedic surgery with pneumatic tourniquet use.
  
  
  METHODS
  Patients were randomized to three groups. Sufentanil was given intravenously at 0.5 microg kg(-1) bolus at the same time that a constant infusion was started at 0.5 microg kg h(-1). In Group 1, continuous infusion of sufentanil was stopped when the tourniquet was released (n = 6). In Group 2, continuous infusion of sufentanil was stopped 15 minutes after tourniquet release (n = 6). In Group 3, as a control group, the sufentanil bolus was started after tourniquet inflation (n = 4).
  
  
  METHODS
  Plasma sufentanil concentrations were determined by radioimmunoassay. To compare pharmacokinetic results, a simulation of the sufentanil plasma concentrations was achieved.
  
  
  RESULTS
  Exsanguination and inflation of the pneumatic tourniquet had no significant effect on pharmacokinetic results. In 75% of patients, a significant increase in sufentanil plasma concentration occurred between 30 and 60 minutes after tourniquet deflation in all three groups, probably as a result of patient mobilization. One respiratory distress event occurred in a Group 2 patient following extubation at 55 minutes after the end of the sufentanil infusion. The rebound of sufentanil concentration was higher in Group 2; it may be due to a reduced effect of the restoring circulation in the ischemic leg by a prolonged infusion after tourniquet deflation.
  
  
  CONCLUSIONS
  Using a pneumatic tourniquet induces transient changes in the pharmacokinetics of sufentanil. These changes may have clinical relevance during the first hour after tourniquet release.
authors.affiliation: Service d'Anesthésie-Réanimation Chirurgicale 2, Centre Hospitalier Régional et Universitaire, Rennes, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Estebe
authors.forename: P
authors.initials: P
authors.lastname: Le Corre
authors.forename: J C
authors.initials: JC
authors.lastname: Levron
authors.forename: J P
authors.initials: JP
authors.lastname: Le Moing
authors.forename: A
authors.initials: A
authors.lastname: Le Naoures
authors.forename: C
authors.initials: C
authors.lastname: Ecoffey
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D011863:Radioimmunoassay; D017409:Sufentanil / Q000493:pharmacokinetics*; D014111:Tourniquets
chemical_list: D018686:Anesthetics, Intravenous; D017409:Sufentanil