This study assessed the pharmacokinetic and pharmacodynamic behaviour of alfentanil during and after coronary artery bypass grafting (CABG). Twenty-eight patients with good ventricular function having CABG were divided into three groups and premedicated with morphine 0.1 mg.kg-1 IM, scopolamine 0.005 mg.kg-1 IM and diazepam 0.1 mg.kg-1 PO. Group I patients received an infusion of 250 micrograms.kg-1 of alfentanil over one hour coincidental with a second infusion at 2.5 micrograms.kg-1.min-1 which was continued to the end of surgery. Patients in group II received 300 micrograms.kg-1 and 3.0 micrograms.kg-1.min-1 and patients in group III 350 micrograms.kg-1 and 3.5 micrograms.kg-1.min-1. The tracheas of all patients were intubated after receiving alfentanil 96 micrograms.kg-1 and pancuronium 0.15 micrograms.kg-1. Haemodynamic responses to intubation and surgical stimuli (greater than or equal to 20 per cent increase in heart rate and/or systolic blood pressure from control) were treated with isoflurane, one to two per cent inspired, until abolished. Blood samples were taken during and after surgery for plasma alfentanil concentrations which were determined by radioimmunoassay. After surgery the times to awakening and extubation, and alfentanil elimination half-life (t1/2B = 0.693/-k) were determined for each patient. Haemodynamic responses occurred in 20 patients. There were no significant differences in any variable among the groups. The times to awakening and extubation for all patients were 3.2 +/- 0.6 and 8.8 +/- 1.2 hr (mean +/- SEM) respectively. The elimination half-life for all patients was 5.1 +/- 1.0 hr (mean +/- SEM).(ABSTRACT TRUNCATED AT 250 WORDS)
Eight patients were studied to determine the changes in pancuronium requirements during hypothermic cardiopulmonary bypass. They were anaesthetised with fentanyl as the principal agent, ventilated with oxygen and the neuromuscular junction was monitored using train-of-four stimulation. After a bolus dose of pancuronium an infusion was used to maintain the first twitch of the train-of-four at 5-15 per cent of control. Before bypass the mean pancuronium infusion rate was 0.52 (SD 0.16) JJ.glkglmin. There was a small, brief increase in requirement with the initiation of bypass to 0.62 (SD 0.38) JJ.glkglmin, which was folio wed by a decrease of more than 80 per cent during hypothermia to 0.08 (SD 0.03) JJ.glkglmin. Rewarming was associated with a rapid increase in requirement to 0.64 (SD 0.17) JJ.glkglmin, which decreased to 0.33 (SD 0.23) JJ.glkglmin when normothermia was re-established.
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