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Received from the Cardiac Anesthesia Group, and the Henry K. Beecher Memorial Research Laboratories, Department of Anesthesia, Harvard Medical School at the Massachusetts General Hospital, Boston, Massachusetts.
Abstract
The effect of hypothermic hemodilutional cardiopulmonary bypass (CPB) on plasma sufentanil and catecholamine concentrations was studied in four groups of ten patients each, receiving four different doses of sufentanil. Samples for measurement of sufentanial were obtained before CPB, at 15, 30, and 45 minutes of CPB, during rewarming, immediately after and 15, 60, and 240 minutes after CPB. In addition, in groups III and IV, which received the highest dose of sufentanil, blood samples were also obtained for measurement of plasma levels of epinephrine and norepinephrine. Sufentanil concentration decreased in all groups with the start of CPE (group I, 2.92 ± 0.2 to 2.04 ± 0.2; group II, 3.30 ± 0.3 to 1.51 ± 0.2; group III, 7.08 ± 0.7 to 3.45 ± 0.3; group IV, 10.33 ± 0.5 to 4.59 ± 0.5 ng/ ml). No further decreases occurred during CPB but increases occurred with rewarming. The first measurement after CPB approached the concentration before CPB (group I, 2.82 ± 0.3; group II, 2.56 ± 0.5; group III, 4.42 ± 0.4; group IV, 6.10 ± 0.4 ng/ml). Norepinephrine concentrations demonstrated a wide variability with no significant changes. Epinephrine levels increased significantly during rewarming in both groups (group III, 141 ± 23 to 279 ± 79 pg/ml; P < 0.05; group IV, 105 ± 24 to 267 ± 68 pg/ml, P < 0.05). The stability of plasma sufentanil concentrations during CPB suggest that no measureable metabolism or excretion occurred. The increase with rewarming and after CPB suggest significant sequestration. The increase in plasma epinephrine levels with rewarming, when sufentanil concentrations were also increasing, make it unlikely that any clinically acceptable concentration of sufentanil is capable of preventing this response.
Key Words: ANESTHETICS, INTRAVENOUS—sufentanil • SYMPATHETIC NERVOUS SYSTEM—catecholamines • SURGERY—cardiovascular
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  D. C. H. Cheng, J. Karski, C. Peniston, B. Asokumar, G. Raveendran, J. Carroll, H. Nierenberg, S. Roger, D. Mickle, J. Tong, et al. MORBIDITY OUTCOME IN EARLY VERSUS CONVENTIONAL TRACHEAL EXTUBATION AFTER CORONARY ARTERY BYPASS GRAFTING: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL J. Thorac. Cardiovasc. Surg., September 1, 1996; 112(3): 755 - 764. [Abstract] [Full Text]
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