Haemodynamic effects of buprenorphine after heart surgery.

Abstract

All hepatitis B carriers who were HBeAg-positive had high titres of HBsAg; this could not be used as a reliable indicator of the presence of HBeAg, however, because some of the carriers with anti-HBe also had high HBsAg titres. Generally it has been found that many HBsAg carriers have neither HBeAg nor anti-HBe, which reflects the relative insensitivity of immunodiffusion-for example, in our study 2900 of the carriers were e-negative by this test. This number of unclassifiable carriers has made it difficult to evaluate the relation between HBeAg and raised liver enzyme concentrations reported by Maynard et al'6 and Polesky and Hanson."7 By using the more sensitive e-RIA in addition to immunodiffusion we could confirm their observations and show a more precise relation between the presence of HBeAg and raised enzyme concentrations.In acute hepatitis B infections serum liver enzyme concentrations are generally much higher than those in carriers and HBeAg is only transiently present. In chronic asymptomatic carriers persistently, though modestly, raised liver enzyme concentrations appear to be a useful indicator of the presence of e antigen and thus of probable infectivity. Indeed, it is interesting to compare the accuracy of using either immunodiffusion or raised enzyme concentrations to identify the HBeAgpositive carriers. Immunodiffusion identified 12 of the 14 HBeAg-positive sera, whereas 13 were identified by finding raised enzyme concentrations, though at the cost of three anti-HBe sera being incorrectly classified.Testing for the presence of HBeAg is practicable only for specialised laboratories; on the other hand, estimating liver enzyme concentrations is a routine determination in any general hospital. We consider that when assessing the potential infectivity of an indigenous HBsAg carrier in the UK estimating liver enzyme concentrations is a simple and accurate alternative to the specific tests for HBeAg. Haemodynamic effects of buprenorphine after heart surgery Medical_Journal, 1978, 2, 1602-1603 Summary and conclusions The effect of buprenorphine on the cardiovascular system was examined in 11 patients during the period of reduced cardiac reserve after open-heart surgery. Within 10 minutes of giving the full analgesic dose (5 ,_tg/kg) intravenously the mean heart rate had fallen significantly by six beats,'min. Although in two patients the mean arterial pressure fell by 24 mm Hg, there was no overall change in mean arterial pressure, carciiac output, or peripheral resistance. In a further six patients buprenorphine was used successfully as the sole analgesic after open-heart surgery.

The effect of increasing the dose of buprenorphine on the haemodynamic response associated with tracheal intubation

“…The use of buprenorphine has also been reported in cardiac surgery patients [19,20]. Okutani et al found that 12 pg.kg-l provided better suppression of haemodynamic and catecholamine responses than 6 pg.kg when surgery was in progress, but produced a more pronounced decrease in the mean arterial pressure in unstimulated patients after induction [19]. This supports the findings of the present study, that increasing the dose leads to greater depression in unstimulated anaesthetised patients.…”

“…However, when the drug is given during anaesthesia some studies have reported significantly lower heart rates associated with buprenorphine when compared to other opioids such as fentanyl [ 181. The use of buprenorphine has also been reported in cardiac surgery patients [19,20]. Okutani et al found that 12 pg.kg-l provided better suppression of haemodynamic and catecholamine responses than 6 pg.kg when surgery was in progress, but produced a more pronounced decrease in the mean arterial pressure in unstimulated patients after induction [19].…”

Effects of Buprenorphine on Cardiac Repolarization in a Patient with Methadone-Related Torsade de Pointes

“…13 It does not appear to decrease mean arterial pressure, cardiac output, or peripheral arterial resistance, even in patients undergoing open heart surgery. 14 Because of its apparent lack of cardiovascular effects, buprenorphine has been suggested as a preferred treatment for severe pain control in patients with unstable hemodynamic parameters. 15 Buprenorphine inhibits the human ether-a-gogo-related gene (HERG) I Kr in vitro.…”

Pharmacological and clinical importance of narcotic antagonists and mixed antagonists‐use in cardiology.

“…Buprenorphine does not seem to cause histamine release. Malcolm & Coltart (1977) and Rosenfeldt et al (1978) have reported no marked changes in cardiovascular parameters other than a slight reduction in heart rate following buprenorphine 5 or 6 Mg/kg intravenously) in patients after open heart surgery. Studies by Devaux et al (1976) using buprenorphine as a per-operative analgesic have shown a dose-dependent response in certain cardiocirculatory measurements.…”

“…Buprenorphine does not seem to cause histamine release. Malcolm & Coltart (1977) and Rosenfeldt et al (1978) Cardiopulmonary bypass during such procedures is associated with myocardial damage (Archie & Kirklin, 1973) and thus patients studied under these circumstances would be expected to have impaired myocardial performance. We feel that this is a particularly useful situation in which to study a new analgesic agent for, as has been shown with morphine in the situation of acute myocardial infarction, it is in the patients with depressed cardiac reserve that undesirable haemodynamic effects may be apparent even when no such effects have been seen in other studies on patients with normal hearts.…”