Abstract
The effect of age on the distribution and elimination of sufentanil was studied in seven elderly (77 ± 5 yr, mean ± SD) and seven younger (41 ± 15 yr) neurosurgical patients. Following a single IV bolus of sufentanil 2 μg · kg−1 multiple arterial samples were obtained at timed intervals and plasma concentrations of sufentanil were measured by radioimmunoassay. Pharmacokinetic variables were calculated from the derived compartmental models. The initial volume of distribution was significantly smaller in the elderly patients (310 ± 109ml · kg−1 vs 491 ± 112 ml · kg−1 mean ± SD). Elimination halflives, plasma clearances, and total volumes of distribution were similar for elderly and younger subjects. Six of seven elderly patients required administration of naloxone at the termination of surgery to achieve an adequate rale of ventilation (> eight breaths · min−1) while only one younger patient required antagonism of ventilatory depression. The authors believe that agerelated differences in the action of sufentanil cannot be accounted for by the observed differences in the initial volume of distribution. It is concluded that alterations in pharmacodyamics appear to be of greater importance in the prolonged opioid effect seen in the elderly.
L’effet de l’âge sur la distribution et l’élimination du sufentanil a été étudié chez sept patients âgés (77 ± 5 ans, moyenne ± SD) et sept patients moins âgés (41 ± 15 ans) devant subir des procedures neurochirurgicales. Après un bolus intraveineux unique de sufentanil de 2 μg · kg−1, des échantillons artériels multiples out été obtenus à des intervalles règuliers et des concentrations plasmatiques de sufentanil out été mesurées par radio-immuno-essai. Les variables pharmacocinétiques out été calculées. Le volume initial de distribution était significativement plus petit chez les patients plus ages (310 ± 109 ml · kg−1 moyenne ± SD). Les demivies d’élimination, les clairances plasmatiques, les volumes totaiix de distribution étaient similaires pour les patients ages et les sujets pl us jeunes. Six des sept patients ages out requis l’administration de naloxone à la fin de la chirurgie afin d’acquérir une fréquence de ventilation adequate (> 8 respirations · min−1) alors qu’un sent patient plus jeune a requis un antagonisme de sa depression respiratoire. Les auteurs croienl que les differences reliees à l’âge dans l’effet du sufentanil ne peuvent être attribuées aux differences du volume de distribution initial. On conclut que les altérations de la pharmacodynamique apparaissent plus importante dans la prolongation des effets des opiacés observes chez les gens ages.
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This study was supported in part by a grant from Janssen Pharmaceutica Inc.
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Matteo, R.S., Schwartz, A.E., Ornstein, E. et al. Pharmacokinetics of sufentanil in the elderly surgical patient. Can J Anaesth 37, 852–856 (1990). https://doi.org/10.1007/BF03006620
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DOI: https://doi.org/10.1007/BF03006620