• R J Hudson, B T Henderson, I R Thomson, M Moon, and M D Peterson.
• Department of Anesthesia, University of Manitoba, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Manitoba, Canada R2H 2A6. rhudson@cc.umanitoba.ca
• J. Cardiothorac. Vasc. Anesth. 2001 Dec 1;15(6):693-9.

ObjectiveTo determine the pharmacokinetics of sufentanil in patients undergoing coronary artery bypass graft surgery.DesignProspective, multigroup study.SettingUniversity-affiliated hospital.ParticipantsPatients with good left ventricular function undergoing elective surgery (n = 103).InterventionsSufentanil 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.Measurements And Main ResultsThe 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.ConclusionThe 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.Copyright 2001 by W.B. Saunders Company

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