title: Fentanyl clearance and volume of distribution are increased in patients with major burns.
abstract: This study examined the pharmacokinetics of fentanyl in burned patients during the hyperdynamic phase. Twenty adults, aged 37 +/- 2 years (mean +/- SE), with 49 +/- 3% total body surface area burn, were studied at 17 +/- 2 days after the injury and compared to demographically matched controls. After a 200-microg IV bolus of fentanyl, blood samples (n = 20) were collected for 4.5 hours. Concentration-time curves were fitted to a 2-compartment model. Burned patients had a higher cardiac index. Median fentanyl clearance (CL, 21.0 vs 29.4 mL/kg/min), central compartment volume (V(1), 0.37 vs 0.61 L/kg), and total volume of distribution (V(area), 3.6 vs 5.8 L/kg) were higher in burned patients. Cardiac index was unrelated to CL. The increased V(1) and V(area) are likely due to large intravenous fluid replacement and tissue edema. Higher CL and larger V(1) and V(area) leading to a lower fentanyl plasma concentration may partially explain the increased opiate requirement previously observed after burn injury.
authors.affiliation: Department of Anesthesia, University of Iowa Hospitals and Clinics, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA. anthony-han@uiowa.edu
authors.forename: Taehyung
authors.initials: T
authors.lastname: Han
authors.forename: Jerold S
authors.initials: JS
authors.lastname: Harmatz
authors.forename: David J
authors.initials: DJ
authors.lastname: Greenblatt
authors.forename: J A Jeevendra
authors.initials: JA
authors.lastname: Martyn
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D002056:Burns / Q000188:drug therapy*; D005260:Female; D005283:Fentanyl / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D006207:Half-Life; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D008954:Models, Biological
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl