Sufentanil pharmacokinetics in pediatric cardiovascular patients

Abstract

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. A tri-exponential equation best described the time-concentration data in all patients. Clearance rate (Cl) was 6.7 +/- 6.1 ml.kg-1.min-1 (+/- SD) in neonates, which was significantly lower than the values of 18.1 +/- 2.7, 16.9 +/- 3.2, and 13.1 +/- 3.6 ml.kg-1 min-1 observed in infants, children, and adolescents, respectively. The volume of distribution at steady state (Vdss) was 4.15 +/- 1.0 L/kg in neonates, significantly greater than the values of 2.73 +/- 0.5 and 2.75 +/- 0.5 L/kg observed in children and adolescents, respectively. 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.