Evaluation of plasma fentanyl concentrations in infants during cardiopulmonary bypass with low-volume circuits
Evaluation of plasma fentanyl concentrations in infants during cardiopulmonary bypass with low-volume circuits
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DOI：
10.1053/j.jvca.2005.03.008
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发表时间：
2005-06-01
影响因子：
2.8
通讯作者：
Laussen, PC
中科院分区：
文献类型：
--
作者：
Kussman, BD;Zurakowski, D;Laussen, PC
目的：本研究的目的是测量在使用低预充容量的旁路回路的婴儿心脏手术期间血浆芬太尼浓度的变化，并检查血浆芬太尼浓度和温度与脑电双频指数（BIS）的关系，脑电双频指数（BIS）是婴儿心脏手术期间意识水平的指标。15名新生儿和婴儿接受心脏手术与低温心肺转流（CPB）。干预措施：患者麻醉与芬太尼，接受30 μ g/kg推注诱导立即由连续输注0.3 μ g/kg/min，直到皮肤关闭。测量和主要结果：在诱导前、诱导后30分钟、胸骨切开术、主动脉插管术、CPB上4、30和60分钟以及CPB下1和30分钟测量术中数据和总血浆芬太尼浓度。在CPB开始时，芬太尼从15 +/- 6降至11 +/- 5 ng/mL（p < 0.01），在CPB 30分钟时增加至16 +/- 5 ng/mL（p < 0.01），并保持相似水平，直至CPB结束30分钟。诱导时BIS从88 +/- 20降至42 +/- 11（p = 0.02），冷却期间进一步降至最低温度时的9 +/- 11（p < 0.001），复温期间升高至CPB后1分钟时的29 +/- 9（p < 0.001）和30分钟时的35 +/-10（p < 0.01）。由于广泛的个体差异BIS，芬太尼和BIS和temperature.Conclusions之间没有显着的相关性：在手术过程中使用低容量旁路电路和芬太尼的恒定输注血浆芬太尼浓度的变异性最小。婴儿心脏手术期间使用BIS的效用似乎很小，芬太尼浓度、温度和BIS之间没有关系。(c)2005年爱思唯尔公司All rights reserved.
Objective: The purpose of the study was to measure changes in plasma fentanyl concentrations during infant cardiac surgery using a bypass circuit with low priming volume and to examine the relation of plasma fentanyl concentration and temperature to Bispectral Index (BIS) as an index of conscious level during infant cardiac surgery.Design: Prospective cohort study.Setting: Tertiary care, academic children's hospital.Participants: Fifteen neonates and infants undergoing cardiac surgery with hypothermic cardiopulmonary bypass (CPB).Interventions: Patients were anesthetized with fentanyl, receiving a 30 mu g/kg bolus for induction immediately followed by continuous infusion of 0.3 mu g/kg/min until skin closure.Measurements and Main Results: Intraoperative data and total plasma fentanyl concentration were measured at pre-induction; 30 minutes postinduction; sternotomy; aortic cannulation; at 4, 30, and 60 minutes on CPB; and at 1 and 30 minutes off CPB. At the onset of CPB, fentanyl declined from 15 +/- 6 to 11 +/- 5 ng/mL (p < 0.01), increasing to 16 +/- 5 ng/mL (p < 0.01) at 30 minutes on CPB and maintaining a similar level until 30 minutes off CPB. BIS decreased from 88 +/- 20 to 42 +/- 11 (p = 0.02) with induction, declined further during cooling to 9 +/- 11 at the nadir temperature (p < 0.001), and increased during rewarming to 29 +/- 9 at 1 minute (p < 0.001) and 35 10 at 30 minutes off CPB (p < 0.01). Because of wide individual variation in BIS, there was no significant correlation between fentanyl and BIS and temperature.Conclusions: There was minimal variability in the plasma fentanyl concentration using a low-volume bypass circuit and constant infusion of fentanyl during surgery. There appears to be minimal utility for using BIS during infant cardiac surgery with no relationship between fentanyl concentration, temperature, and BIS established. (c) 2005 Elsevier Inc. All rights reserved.