Abstract
F is a useful anesthetic in cardiac surgery; however, an optimal F dosage for children has not been defined on the basis of pharmacokinetic analysis. We studied 19 patients (5 mo-16 yr) at cardiac surgery with cardiopulmonary bypass (CPB). An F bolus of 50 or 30 mcg/kg was given over 30 sec. with concomitant initiation of F continuous infusion at a rate of .15 or .3 mcg/kg/ min. F plasma concentrations of 30 minutes were up to 3-fold higher than reported with similar regimens in adults. The calculated mean values for T½ α (10.2 min); T½ β (102 min); and TBC (13.3 ml/kg/min) were close to adult whereas the mean Vdss (1.2 L/kg) was significantly lower. There was a positive correlation between age and Vdss (r=0.85; p<0.01), and a negative correlation between age and TBC (r=-0.73, p<0.05. Following the commencement of CPB there was a 74% mean decrease in F levels, much greater than would have been expected from hemodilution alone. Sequestration of F by the CPB with binding to both the membrane oxygenator (major) and to the siliconized tubing (minor) accounts for much of the steep decrease in F levels. During CPB and hypothermia F concentrations remained low but stable probably reflecting a significant reduction in hepatic metabolism of F. Our data suggest an optimal pediatric F dose of 30 mcg/kg given as a bolus combined with an infusion of 0.3 mcg/kg/min throughout surgery.
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Koren, G., Goresky, G., Crean, P. et al. UNEXPECTED ABNORMALITIES OF FENTANYL (F) DISPOSITION IN CHILDREN UNDERGOING CARDIAC SURGERY. Pediatr Res 18 (Suppl 4), 154 (1984). https://doi.org/10.1203/00006450-198404001-00366
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DOI: https://doi.org/10.1203/00006450-198404001-00366