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Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery.

Barbosa RA, Santos SR, White PF, Pereira VA, Silva Filho CR, Malbouisson LM, Carmona MJ - Clinics (Sao Paulo) (2009)

Bottom Line: Data were analyzed using ANOVA, considering p<0.05 as significant.Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 +/- 117 vs. 216 +/- 85 min, p = 0.04).Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

View Article: PubMed Central - PubMed

Affiliation: Serviço de Anestesiologia e Terapia Intensiva Cirúrgica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. navajasbarbosa@superig.com.br

ABSTRACT

Purpose: Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass.

Methods: Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10) or off-pump coronary artery bypass graft (group, n=10) coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 microg/mL). Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p<0.05 as significant.

Results: After cardiopulmonary bypass, despite similar plasma propofol concentrations in both groups, bispectral index values were lower in the on-pump coronary artery bypass graft group. Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 +/- 117 vs. 216 +/- 85 min, p = 0.04). Patients undergoing cardiopulmonary bypass had shorter biological (1.82 +/- 0.5 vs. 3.67 +/- 1.15 h, p < 0.01) and terminal elimination (6.27 +/- 1.29 vs. 10.5h +/- 2.18, p < 0.01) half-life values, as well as higher total plasma clearance (28.36 +/- 11.40 vs.18.29 +/- 7.67 mL/kg/min, p = 0.03), compared to patients in the off-pump coronary artery bypass graft group.

Conclusion: Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

Show MeSH
Pharmacokinetic-pharmacodynamic modeling using sigmoid EMAX model of plasma propofol concentration and bispectral index (BIS) values during and after surgery
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f4-12-oa-0209: Pharmacokinetic-pharmacodynamic modeling using sigmoid EMAX model of plasma propofol concentration and bispectral index (BIS) values during and after surgery

Mentions: During the postoperative period, BIS values were significantly higher in the OPCAB group in comparison to the CABG group, as shown in figure 3. PK-PD modeling performed by plotting the BIS values as a function of the plasma concentrations demonstrated hysteresis between the CABG and OPCAB group curves, as shown in figure 4. For the same plasma propofol concentrations in the wakening period, higher values of BIS are observed in the OPCAB group. Table 3 displays the results of the sigmoid EMAX model applied to both groups, with r2= 0.95 in the OPCAB group and r2= 0.96 in the CABG group.


Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery.

Barbosa RA, Santos SR, White PF, Pereira VA, Silva Filho CR, Malbouisson LM, Carmona MJ - Clinics (Sao Paulo) (2009)

Pharmacokinetic-pharmacodynamic modeling using sigmoid EMAX model of plasma propofol concentration and bispectral index (BIS) values during and after surgery
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666455&req=5

f4-12-oa-0209: Pharmacokinetic-pharmacodynamic modeling using sigmoid EMAX model of plasma propofol concentration and bispectral index (BIS) values during and after surgery
Mentions: During the postoperative period, BIS values were significantly higher in the OPCAB group in comparison to the CABG group, as shown in figure 3. PK-PD modeling performed by plotting the BIS values as a function of the plasma concentrations demonstrated hysteresis between the CABG and OPCAB group curves, as shown in figure 4. For the same plasma propofol concentrations in the wakening period, higher values of BIS are observed in the OPCAB group. Table 3 displays the results of the sigmoid EMAX model applied to both groups, with r2= 0.95 in the OPCAB group and r2= 0.96 in the CABG group.

Bottom Line: Data were analyzed using ANOVA, considering p<0.05 as significant.Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 +/- 117 vs. 216 +/- 85 min, p = 0.04).Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

View Article: PubMed Central - PubMed

Affiliation: Serviço de Anestesiologia e Terapia Intensiva Cirúrgica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. navajasbarbosa@superig.com.br

ABSTRACT

Purpose: Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass.

Methods: Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10) or off-pump coronary artery bypass graft (group, n=10) coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 microg/mL). Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p<0.05 as significant.

Results: After cardiopulmonary bypass, despite similar plasma propofol concentrations in both groups, bispectral index values were lower in the on-pump coronary artery bypass graft group. Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 +/- 117 vs. 216 +/- 85 min, p = 0.04). Patients undergoing cardiopulmonary bypass had shorter biological (1.82 +/- 0.5 vs. 3.67 +/- 1.15 h, p < 0.01) and terminal elimination (6.27 +/- 1.29 vs. 10.5h +/- 2.18, p < 0.01) half-life values, as well as higher total plasma clearance (28.36 +/- 11.40 vs.18.29 +/- 7.67 mL/kg/min, p = 0.03), compared to patients in the off-pump coronary artery bypass graft group.

Conclusion: Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

Show MeSH