Abstract
Objective
Pharmacokinetics and haemodynamic effects of a total dose of 15 µg·kg-1 sufentanil, an opioid anaesthetic agent, were studied in patients undergoing aortocoronary bypass surgery at three infusion rates of 30 (group I), 5 (group II), and 2 (group III) µg·kg-1·min-1, respectively.
Results
Plasma concentrations of sufentanil could be optimally characterized by a linear biexponential pharmacokinetic model. Non-compartmental analyses indicated that there was no significant difference in the values of clearance (11.6, 13.3, 14.3 ml·min-1·kg-1), steady-state volume of distribution (0.220, 0.255 and 0.331 l·kg-1) and mean residence time (18.8, 13.3 and 14.3 min) among the groups. The observed mean Cmax values of 421 (group I), 125 (group II), and 53 (group III) ng · ml-1 and observed mean AUC values from 0 to 3 min were all consistent with the dosing regimens. There were large inter-individual variations in haemodynamic response. Compared to plasma data, a delay in haemodynamic effects was found. Times to reach peak haemodynamic effect ranged from 4.3 to 4.9 min for group I, from 4.6 to 6.1 min for group II, and from 9.9 to 11.3 for group III. Except heart rate, peak haemodynamic effects in these study patients generally ranged from 20.9% to 35.2%. Significant reductions in the area under the effect-time profiles of mean arterial blood pressure and systemic vascular resistance were observed in group II and group III, but not in group I. Significant reductions in the area under the effect-time profiles of left ventricular stroke work index were observed in group III only. No effect on heart rate was found in any group.
Conclusion
Our findings suggested that a slower infusion rate of sufentanil at a dose of 15 µg·kg-1 tends to give a greater reduction in mean arterial blood pressure, systemic vascular resistance, and left ventricular stroke work index than does a faster infusion rate.
Similar content being viewed by others
References
Lowenstein E, Hallowell P, Levine FH, Daggett WM, Austen WG, Laver MG (1969) Cardiovascular responses to large doses of intravenous morphine in man. N Engl J Med 281: 1389–1393
Sebel PS, Bovil JG (1982) Cardiovascular effects of sufentanil anaesthesia. Anesth Analg 61: 115–119
Waller JL, Hug CC, Nagle DM, Craver JM (1981) Haemodynamic changes during fentanyl-oxygen anaesthesia for aortocoronary bypass operation. Anesthesiology 55: 212–217
Stanley TH, Philbin DM, Coggins CH (1979) Fentanyl-oxygen anaesthesia for coronary artery surgery: cardiovascular and antidiuretic hormone responses. Can Anaesth Soc J 26: 168–171
Weldon ST, Perry DF, Cork RC, Gandolfi AJ (1985) Detection of picogram levels of sufentanil by capillary gas chromatography. Anesthesiology 63: 684–687
Howie MB, McSweeney TD, Lingam RP, Maschke SP (1985) A comparison of Fentanyl-O2 and sufentanil-O2 for cardiac anesthesia. Anesth Analg 64: 877–887
Bovill JG, Sebel PS, Fiolet JWT, Touber JL, Kok K, Philbin DM (1983) The influence of sufentanil on endocrine and metabolic responses to cardiac surgery. Anesth Analg 62: 391–397
Willens JS, Myslinski NR (1993) Pharmacodynamics, pharmacokinetics, and clinical uses of fentanyl, sufentanil, and alfentanil. Heart Lung 22: 239–251
Bovill JG, Sebel PS, Blackburn CL, Oei-Lim V, Heykants JJ (1984) The pharmacokinetics of sufentanil in surgical patients. Anesthesiology 61: 502–506
Helmers JHJH, van Leeuwen L, Zuurmond WWM (1994) Sufentanil pharmacokinetics in young adult and elderly surgical patients. Eur J Anaesthesiol 11: 181–185
Lehmann KA, Sipakis K, Gasparint R, van Peer A (1993) Pharmacokinetics of sufentanil in general surgical patients under different conditions of anaesthesia. Acta Anaesthesiol Scand 37: 176–180
Rosow CE (1984) A new opioid analgesic for use in anaesthesia. Pharmacotherapy 4: 11–19
DeLange S, Boscoe MJ, Stanley TH, Pace N (1982) Comparison of sufentanil-O2 and fentanyl-O2 for coronary artery surgery. Anesthesiology 56: 112–118
Karasawa F, Iwanov V, Moulds RFW (1993) Sufentanil and alfentanil cause vasorelaxation by mechanisms independent of the endothelium. Clin Exp Pharmacol Physiol 20: 705–711
Schafer SL, Varvel JR (1991) Pharmacokinetics, pharmacodynamics, and rational opioid selection. Anesthesiology 74: 53–63
Philbin DM, Rosow CE, Schneider RC, Koski G,D’Ambra MN (1990) Fentanyl and sufentanil anaesthesia revisited: How much is enough? Anesthesiology 73: 5–11
Rosow CE, Philbin DM, Keegan CR, Moss J (1984) Hemodynamics and histamine release during induction with sufentanil or fentanyl. Anesthesiology 60: 489–491
Kleinbloesem CH, Van Brummelen P, Danhof M, Faber H, Urquhart J, Breimer OD (1987) Rate of increase in the plasma concentration of nifedipine as a major determinant of its hemodynamic effects in humans. Clin Pharmacol Ther 41: 26–30
Mathews HML, Furness G, Carson IW, Orr IA, Lyons S, Clarke RSJ (1988) Comparison of sufentanil-oxygen and fentanyl-oxygen anaesthesia for coronary artery bypass grafting. Br J Anaesth 60: 530–535
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Borenstein, M., Shupak, R., Barnette, R. et al. Cardiovascular effects of different infusion rates of sufentanil in patients undergoing coronary surgery. Eur J Clin Pharmacol 51, 359–366 (1997). https://doi.org/10.1007/s002280050214
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s002280050214