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An allometric pharmacokinetic model and minimum effective analgesic concentration of fentanyl in patients undergoing major abdominal surgery

Title
An allometric pharmacokinetic model and minimum effective analgesic concentration of fentanyl in patients undergoing major abdominal surgery
Authors
Bae, JayyoungKwon, MiyoungLee, Yong-HunLee, Eun-KyungChoi, Byung-MoonNoh, Gyu-Jeong
Ewha Authors
이은경
SCOPUS Author ID
이은경scopus
Issue Date
2020
Journal Title
BRITISH JOURNAL OF ANAESTHESIA
ISSN
0007-0912JCR Link

1471-6771JCR Link
Citation
BRITISH JOURNAL OF ANAESTHESIA vol. 125, no. 6, pp. 976 - 985
Keywords
effectiveconcentrationfentanylpainpharmacodynamicspharmacokineticspostoperative pain
Publisher
ELSEVIER SCI LTD
Indexed
SCIE; SCOPUS WOS scopus
Document Type
Article
Abstract
Background: We aimed to characterise the population pharmacokinetics of fentanyl in adults and to determine the minimum effective concentration (MEC) and minimum effective analgesic concentration (MEAC) of i.v. fentanyl in patients after major abdominal open surgery. Methods: In the pharmacokinetic study, subjects received an intravenous bolus of fentanyl 100 mu g during operation, and arterial blood was sampled at pre-set intervals. In addition, data from previously published fentanyl pharmacokinetic studies were incorporated to build a pharmacokinetic model. In the MEAC study, subjects were asked to rate their pain every 10 min using a VAS (0=no pain, 10=most severe pain) in the PACU. The first blood sample was obtained when wound pain was rated as >= 3 at rest or >= 5 during compression. Then, fentanyl 50 mu g was administered every 10 min until the pain intensity had decreased to <3 at rest and <5 during compression, at which point the second blood was sampled and the first MEAC of fentanyl was measured. The same procedure was repeated to obtain a third sample (MEC) and a fourth sample (second MEAC). Results: In the population pharmacokinetic study (n=95), the plasma concentration of fentanyl over time was well-described by the three-compartment mammillary model using an allometric expression. The V1, V2, V3, Cl, Q1, and Q2 of a 70 kg subject were 10.1, 26.5, 206 L, 0.704, 2.38, and 1.49 L min(-1), respectively. In the MEAC study (n=30), the median (inter-quartile range) MEC and MEAC were 0.72 (0.58-1.05) ng ml(-1), and 0.99 (0.76-1.28) ng ml(-1) , respectively. Conclusion: These results provide a scientific basis for the use of fentanyl for acute postoperative pain management in surgical patients.
DOI
10.1016/j.bja.2020.06.066
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자연과학대학 > 통계학전공 > Journal papers
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