Pharmacokinetic model-driven infusion of sufentanil and midazolam during cardiac surgery: Assessment of the prospective predictive accuracy and the quality of anesthesia

Changes in total and unbound concentrations of sufentanil during target controlled infusion for cardiac surgery with cardiopulmonary bypass

“…Bailey et al 16 used for cardiac anaesthesia an older model from Hudson, which had been developed from abdominal aortic surgery, 17 and reported measured concentrations which were about 100% higher than targeted. The only study with sufentanil TCI in cardiac anaesthesia using the Gepts 9 They reported only a slight overprediction before CPB (MDPE¼26.8%), but a clear overprediction during and after CPB when the measured concentrations were 42% lower than targeted. Such a decrease in the total sufentanil concentration after start of CPB was also seen in our study (Fig.…”

“…7 8 However, significant inaccuracies between measured and model-predicted sufentanil drug concentrations have been reported to occur during CPB when sufentanil was administered with TCI. 9 Drug effect is connected to the free fraction of the drug, which describes the amount of drug not bound in plasma proteins or blood cells. To our knowledge, there is no previous information on the effect of CPB on the free amount of sufentanil.…”

Midazolam suppresses thrombin‐induced heat shock protein 27 phosphorylation through inhibition of p38 mitogen‐activated protein kinase in cardiac myocytes

“…It has been shown that both volatile and intravenous anesthetics have cardiac protective effect against ischemic damage [Zaugg et al, 2003a,b]. Intravenous anesthetics such as midazolam are administered in the patients with cardiac ischemic diseases and undergoing coronary artery bypass graft [Shafer, 1998; Barvais et al, 2000]. It has been reported that midazolam has direct effects on cardiac myocytes and vascular smooth muscle cells, resulting in modulation of cardiac function and decreasing systemic blood pressure [Shafer, 1998; Kanaya et al, 2002; Tanabe et al, 2002, 2003].…”

Performance of the Minto model for the target‐controlled infusion of remifentanil during cardiopulmonary bypass

“…However, the number of samples before bypass was fewer than those during bypass, and this might have influenced the results. Similarly, previous authors reported better predictive performance of a TCI model using sufentanil in the (pre‐bypass) period when more samples were extracted than in other (during and after bypass) periods (six vs. two samples each), and discussed it as one of the limitations of their study . Moreover, the study subjects were patients undergoing cardiac surgery in this study.…”

“…Regarding TCI models, the Gepts model for sufentanil had significant overprediction (MDPE, −42.1%) and inaccuracy (MDAPE, 40.9%) during and after bypass with moderate hypothermia . On the other hand, the model showed clinically acceptable performance (MDPE, 3.9%) during normothermic bypass in patients having coronary artery bypass .…”