Articles: anesthetics.
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Anesthesia and analgesia · Nov 1987
Sufentanil pharmacokinetics in pediatric cardiovascular patients.
The pharmacokinetics of sufentanil were studied in 28 pediatric patients undergoing cardiovascular procedures. Patients were divided into four groups on the basis of age: neonates (0-1 month, n = 9), infants (1-24 months, n = 7), children (2-12 yr, n = 7), and adolescents (12-18 yr, n = 5). Sufentanil 10-15 micrograms/kg, was administered by IV bolus and plasma concentrations measured for up to 20 hr. ⋯ The elimination half-life (T1/2 beta) was 783 +/- 346 min in neonates, significantly longer than the values of 214 +/- 41, 140 +/- 30, and 209 +/- 23 min observed in infants, children, and adolescents, respectively. The plasma concentration of sufentanil at the time of additional anesthetic supplementation to suppress hemodynamic responses to surgical stimulation was 2.51 ng/ml in neonates, significantly higher than the levels of 1.58, 1.53, and 1.56 ng/ml observed in infants, children, and adolescents, respectively. The authors conclude that age-related differences in pharmacokinetic and pharmacodynamic properties of sufentanil are evident in pediatric patients with major cardiovascular disease who are undergoing cardiovascular surgery.
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Anaesth Intensive Care · Nov 1987
Comparative Study Clinical Trial Controlled Clinical TrialComparison of propofol and antagonised midazolam anaesthesia for day-case surgery.
A technique of midazolam/fentanyl/isoflurane/nitrous oxide anaesthesia, in which the benzodiazepine was antagonised by the specific antagonist, flumazenil, was compared with propofol/fentanyl/nitrous oxide anaesthesia for minor outpatient urological surgery. No significant difference was found in the overall ease of anaesthesia; however, using subjective (linear analogue sedation scales) and objective (letter deletion and simple reflex time) tests, recovery was found to be significantly slower for the antagonised midazolam group. ⋯ The midazolam group displayed the greatest degree of residual sedation at the 4-hour time of discharge and on arrival home a significantly larger number of patients in the midazolam group slept for a period. It is likely that the dose of flumazenil chosen (1 mg) was inadequate to completely antagonise the dose of midazolam (mean 17 mg) for the full duration of recovery.
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The pharmacokinetics of alfentanil were studied in 18 children (3 months to 14 yr of age) undergoing surgery. Alfentanil was administered as a 30-s infusion of either 50 or 120 micrograms.kg-1. Pharmacokinetic values were independent of dose. ⋯ The mean value of Vdss was 0.419 (SE .028) l.kg-1) for the whole group, and elimination t1/2 was 76.3 (SE 6.5) min. The clearance rate [TBC = 7.9 (SE 0.41) ml.kg-1.min-1] was within the range of values previously determined in adult studies. From these data, it would appear that, although there may be differences in the disposition kinetics between children aged 3 months to 14 yr and those measured in adults in some studies by other investigators, age-related differences within this group were not demonstrable.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Hemodynamic action profile of propofol in comparison with midazolam. A study in coronary surgical patients].
Propofol, a rapid and short-acting i.v. anesthetic, was associated with the risk of anaphylactic reactions in its original cremophor-EL formulation. It has been reformulated in a soybean emulsion with satisfactory anesthetic properties. A former study of hemodynamic changes after i.v. induction with propofol, thiopental, methohexital, etomidate, and midazolam in patients with coronary artery disease demonstrated that in comparison to other induction agents propofol depressed systolic and diastolic arterial pressures more severely, compromising coronary perfusion. ⋯ Propofol decreased systolic and diastolic pressures (-27%, -22%) more than midazolam (-10%, -9%). Cardiac index and stroke volume index were diminished following both drugs (propofol: -14%, -9%; midazolam: -15%, -11%); total systemic resistance was reduced significantly by propofol (-22%). Dp/dtmax was compromised more markedly by propofol (-24%) than by midazolam (-18%), but there was no significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)