Lipid-soluble basic drugs may be sequestered as the drug-loaded blood passes through the pulmonary capillaries [1], and the amount of drug remaining in the blood for distribution to the organism may be substantially reduced by this mechanism. The temporary sequestration of a significant proportion of an i.v. dose of a drug by the lung may influence the intensity and duration of its pharmacological effect [2]. Hess, Herz and Friedel [3] reported that rabbit lung had a high affinity for fentanyl: approximately 24 % of the dose administered was sequestered as the drug passed through the lung for the first time ("first pass"). Several reports demonstrated a high fentanyl binding capacity of the human lung [4-7]. This paper describes quantitatively the pulmonary kinetics of fentanyl and alfentanil in patients suffering from coronary artery disease. PATIENTS AND METHODS After approval was granted by the local ethics committee for an investigation into the pulmonary kinetics of fentanyl and alfentanil in surgical patients, informed consent was obtained from 11 patients (10 male) scheduled to undergo elective coronary artery bypass surgery. Patients ranged in age from 36 to 67 yr and in body weight from 71 to 81 kg. They were divided into two groups: fentanyl (five patients; Nos 1-5. No. 5 was the