Pilot study on the effect of tourniquet use on sufentanil pharmacokinetics.

Autor: Estebe JP; Service d'Anesthésie-Réanimation Chirurgicale 2, Centre Hospitalier Régional et Universitaire, Rennes, France., Le Corre P, Levron JC, Le Moing JP, Le Naoures A, Ecoffey C
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2002 Dec; Vol. 14 (8), pp. 578-83.
DOI: 10.1016/s0952-8180(02)00458-0
Abstrakt: Study Objective: To test our hypothesis that sequestration of sufentanil can occur during surgery when a pneumatic tourniquet is used.
Design: Prospective, randomized study.
Setting: Operating room and recovery room of a university hospital.
Patients: 16 ASA physical status I and II patients scheduled for orthopedic surgery with pneumatic tourniquet use.
Intervention: Patients were randomized to three groups. Sufentanil was given intravenously at 0.5 microg kg(-1) bolus at the same time that a constant infusion was started at 0.5 microg kg h(-1). In Group 1, continuous infusion of sufentanil was stopped when the tourniquet was released (n = 6). In Group 2, continuous infusion of sufentanil was stopped 15 minutes after tourniquet release (n = 6). In Group 3, as a control group, the sufentanil bolus was started after tourniquet inflation (n = 4).
Measurements: Plasma sufentanil concentrations were determined by radioimmunoassay. To compare pharmacokinetic results, a simulation of the sufentanil plasma concentrations was achieved.
Main Results: Exsanguination and inflation of the pneumatic tourniquet had no significant effect on pharmacokinetic results. In 75% of patients, a significant increase in sufentanil plasma concentration occurred between 30 and 60 minutes after tourniquet deflation in all three groups, probably as a result of patient mobilization. One respiratory distress event occurred in a Group 2 patient following extubation at 55 minutes after the end of the sufentanil infusion. The rebound of sufentanil concentration was higher in Group 2; it may be due to a reduced effect of the restoring circulation in the ischemic leg by a prolonged infusion after tourniquet deflation.
Conclusions: Using a pneumatic tourniquet induces transient changes in the pharmacokinetics of sufentanil. These changes may have clinical relevance during the first hour after tourniquet release.
Databáze: MEDLINE
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