Abstract
Purpose
Smoking affects the pharmacodynamic and pharmacokinetic behaviour of several drugs. In smokers, induction of anaesthesia is often stormy. In this study we have determined whether cigarette smoking affected thiopentone pharmacodynamic or pharmacokinetic behaviour during induction of anaesthesia.
Methods
Fifteen smokers and 15 non-smokers, scheduled for elective surgery, were studied. Heart rate, invasive arterial pressures and middle latency auditory evoked potentials were recorded awake and during thiopentone induction (9 mg·kg−1 lean body mass), before and after tracheal intubation. Blood was sampled up to 24 hr after induction to measure thiopentone plasma concentrations and to calculate pharmacokinetic parameters.
Results
Anaesthesia was adequate in all patients, although haemodynamic intubation response was not blunted. Latencies or amplitudes of middle latency auditory evoked potentials (MLAEP) did not differ between the groups. The postintubation latencies of Nb waves were 48.9 ± 8.1 msec (mean ± SD) in smokers and 48.1 ± 8.5 msec in nonsmokers. Pharmacokinetic data showed no differences between smokers and non-smokers. Clearance of thiopentone was 2.9 ± 1.1 ml·min−1 ·kg−1 in smokers and 3.3 ± 1.0 ml·min−1 ·kg−1 in non-smokers and elimination half life of thiopentone was 12.5 ± 6.3 hr in smokers and 10.7 ± 3.1 hr in non-smokers, respectively. The haemodynamic response after the induction dose of thiopentone and after tracheal intubation were similar in smokers and non-smokers. Mean postintubation systolic arterial pressures were 192 ± 35 vs 189 ± 20 mmHg and mean postintubation heart rates were 103 ± 12 vs 102 ± 17 beat per minute (bpm) in smokers and non-smokers, respectively.
Conclusion
We conclude, that cigarette smoking does not affect the pharmacodynamic or pharmacokinetic behaviour of thiopentone.
Résumé
Objectif
Le tabagisme influence le comportement pharmacodynamique et pharmacocinétique de plusieurs produits. Chez le fumeur, l’induction de l’anesthésie est souvent mouvementée. Cette étude visait à déterminer si la cigarette affectait le comportement pharmacodynamique et phamnacocinétique du thiopental pendant l’induction de l’anesthésie.
Méthodes
Quinze fumeurs et 15 non fumeurs programmés pour une intervention non urgente participaient à l’étude. La fréquence cardiaque, la pression artérielle sanglante et les potentiels auditifs de latence moyenne ont été enregistrés à l’état vigile et pendant l’induction de l’anesthésie au thiopental (9 mg·kg−1 de poids maigre), avant et après l’intubation de la trachée. Du sang a été prélevé dans les 24 h suivant l’induction pour le dosage plasmatique du thiopental et le calcul des paramètres pharmacocinétiques.
Résultats
Tous les patients ont reçu une anesthésie satisfaisante mais sans qu’il y ait eu abolition de la réponse hémodynamique à l’intubation. Les latences ou amplitudes des potentiels évoqués auditifs de latence moyenne (MLAEP) ne différaient pas entre les groupes. Après l’intubation, la latence des ondes Nb était 48,9 ± 8,1 ms (moyenne ± ÉT) chez le fumeurs et 48,1 ± 8,5 ms chez les non fumeurs. La clairance du thiopental était de 2,9 ± 1,1 ml·min−1 ·kg−1 chez les fumeurs et de 3,3 ± 1,0 ml·min−1 ·kg−1 chez les non fumeurs; la demi-vie d’élimination du thiopental était de 12,5 ± 6,3 chez les fumeurs et de 10,7 ± 3,1 chez les non fumeurs. La réponse hémodynamique après la dose d’induction de thiopental et après l’intubation ne différait pas entre les deux groupes. Après l’intubation, la pression artérielle systolique respective des fumeurs et des non fumeurs était 192 ± 53 vs 189 ± 20 mmHg et la fréquence cardiaque moyenne respective postintubation était 103 ± 12 vs 102 ± 17 bpm.
Conclusion
La cigarette n’a pas d’influence sur le comportement phanmacodynamique et pharmacocinétique du thiopental.
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Teiriä, H., Yli-Hankala, A., Neuvonen, P.J. et al. Cigarette smoking does not affect thiopentone pharmacodynamic or pharmacokinetic behaviour. Can J Anaesth 44, 1269–1274 (1997). https://doi.org/10.1007/BF03012774
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DOI: https://doi.org/10.1007/BF03012774