Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 1987
Sufentanil pharmacokinetics in pediatric cardiovascular patients.
The pharmacokinetics of sufentanil were studied in 28 pediatric patients undergoing cardiovascular procedures. Patients were divided into four groups on the basis of age: neonates (0-1 month, n = 9), infants (1-24 months, n = 7), children (2-12 yr, n = 7), and adolescents (12-18 yr, n = 5). Sufentanil 10-15 micrograms/kg, was administered by IV bolus and plasma concentrations measured for up to 20 hr. ⋯ The elimination half-life (T1/2 beta) was 783 +/- 346 min in neonates, significantly longer than the values of 214 +/- 41, 140 +/- 30, and 209 +/- 23 min observed in infants, children, and adolescents, respectively. The plasma concentration of sufentanil at the time of additional anesthetic supplementation to suppress hemodynamic responses to surgical stimulation was 2.51 ng/ml in neonates, significantly higher than the levels of 1.58, 1.53, and 1.56 ng/ml observed in infants, children, and adolescents, respectively. The authors conclude that age-related differences in pharmacokinetic and pharmacodynamic properties of sufentanil are evident in pediatric patients with major cardiovascular disease who are undergoing cardiovascular surgery.
-
Anesthesia and analgesia · Nov 1987
Venous air embolism and active lung inflation at high and low CVP: a study in "upright" anesthetized sheep.
To assess the safety and efficacy of the maneuver of active lung inflation (ALI) after venous air embolism, measurements were made of pulmonary artery occlusion pressure (PAOP), central venous pressure (CVP), and superior jugular bulb pressure (JbP) as an index of cerebral venous sinus pressure in eight sheep before and after a 2-ml/kg air embolus and before and in the release phase of an ALI to a pressure of 4 kPa (30 mm Hg). (PAOP-CVP) difference decreased significantly after the air embolus with a further decrease after ALI (P less than 0.01). An increase in JbP occurred with ALI only when the CVP was elevated before the injection of air. After air embolism in neurosurgery, ALI may increase the likelihood of paradoxical embolism in patients at risk and may also fail to help in identifying the site of air entry.
-
Anesthesia and analgesia · Oct 1987
End-tidal PCO2 measurements sampled at the distal and proximal ends of the endotracheal tube in infants and children.
To determine whether the site of gas sampling affects end-tidal gas measurements in pediatric patients, end-tidal PCO2 was measured continuously from the distal and proximal ends of the endotracheal tube in 60 infants and children ventilated with an Air-Shields Ventimeter and a partial rebreathing circuit. These data were compared with simultaneous arterial PCO2 measurements. ⋯ In infants and children weighing less than 12 kg, however, only distal end-tidal PCO2 measurements approximated arterial PCO2 measurements. It is concluded that in infants and children weighing less than 12 kg, accurate end-tidal measurements can be obtained only from the distal end of the endotracheal tube.