A Study On Pharmacokinetics Of Sufentanil In Patients With Different Degrees Of Burn

Objective:To investigate the pharmacokinetics of sufentanil in patients with different degrees of burns and to evaluate the accuracy of target-controlled infusion of sufentanil.Methods:40 patients undergoing elective surgery from July 2017 to December 2017 in the Burn Department of the Second Affiliated Hospital of Kunming Medical University were selected.ASA grades were Classified to ?-?.The control group(group A)were 10 patients with scar formation after bum healing and they were performed Scar removal and repair of skin grafts surgery.The left 30 patients were divided into mild burn group(group B),moderate bum group(group C)and severe burn group(group D),10 cases in each group.The iliac arterial puncture and cannulation was performed after the entry into the operatingroom to prepare for continuous monitoring of hemodynamics and collection of specimens.Forty patients underwent continuous intravenous infusion of plasma concentration of 0.4ng/ml for sufentanil and 0.4ug/kg.h for dexmedetomidine,when the micropump showed a effect-site concentration of sufentanil of 0.35ng/ml,begin induce administration with etomidate 0.4 mg/kg,rocuronium bromide 0.9 mg/kg,tracheal intubation was performed at TCI20 time point,mechanical ventilation after intubation,set tidal volume 8-10 ml/Kg,respiratory rate 12 Times/minutes,maintaining Sp02 98%-100%,PetC02 35-45mmHg;Anesthesia maintenance:Sustained TCI models were intravenously administered with sufentanil at a plasma concentration of 0.4 ng/ml and dexmedetomidine at 0.4 ug/kg.h,in addition to compound sevoflurane.Adjust sevoflurane concentration to maintain BIS between 40 and 60.Recording time points:before anesthesia(basis),1 min(TCI1),3 min(TCI3),5 min(TCI5),10 min(TCI10),15 min(TCI15),20 min(TCI20),30 min(TCI30),and 40 min(after TCI)TCI40),50min(TCI50),60min(TCI60),90min(TCI90),withdrawal(T)and withdrawal lmin(T1),3min(T3),5min(T5),8min(T8),10min(T10)and 20 min(T20).Recording elements:cardiac output(CO),stroke volume(SV),mean arterial pressure(MAP),heart rate(HR),bispectral index(BIS),body temperature(T),and collected each time point's Arterial blood,determination of plasma concentration of sufentanil(Cm).Finally calculated pharmacokinetic parameters and TCI accuracy evaluation indicators.Results:1.TCl accuracy evaluation indexDeviation degree:|MDPE|=4.65%(<15%);Accuracy:MDAPE=17.35%(<30%)?2.General informationThe sex,age,height,weight,BMI,infusion volume,urine volume,total sum of sufentanil,time of sufentanil TCI,time from withdrawal of drug to tracheal extubation were measured for the four groups.After one-way analysis of variance,there was no significant difference between the four groups in basic information groups(P>0.05).Preoperative albumin content was lower in group D than in group A and B(P<0.05),and was lower in group C than in group A(P<0.05).There was no significant difference between groups A and B.The differences between groups C and D,B and C were also not obvious.The blood loss and preoperative alanine aminotransferase(ALT)in group D were higher than those in group A,B,and C(P<0.05).There was no significant difference between group A,B,and C.3.CO,SV,MAP,HR,BIS,TThere was no significant difference in SV,BIS,and T between the four groups at each time point(P>0.05);there was no significant difference in CO,HR,MAP between groups A,B,and C at each time point.(P>0.05);The comparison between CO,HR,MAP values in each group was as follows:Compared with A and B groups,group D were statistically different at the time points of basal,TCI1,TCI3,TCI5,TCI10,TCI15,TCI20,TCI30,TCI40,TCI50,TCI60,TCI90,T?T1?T3?T5?T8,T10,and T20.(P<0.05).All the data in group D were higher than group A and B.The differences between group D and group C at time points of basal,TCI1,TCI3,TCI5,TCI10,TCI30,TCI40,TCI50,TCI60,TCI90,T?T1?T3?T5?T8,T10,and T20 also were statistically significant(P<0.05).Those in group D were higher than in group C.4.Sufentanil measured blood concentrationD group was lower than group A at TCI3,TCI5,TCI10,TCI30,TCI40,TCI50,TCI60 and TCI90 points(P<0.05).D group was lower than group B at TCI30,TCI50,TCI60 and TCI90 points(P<0.05).D group was lower than C group at TCI50,TCI60 and TCI90 points(P<0.05).5.Pharmacokinetic parameters of sufentanilThere were significant differences in V3 and T1/2r between group D and group A,B,and C(P<0.05),both of which were higher in group D than in groups A,B,and C.There were significant differences in K31 and CL1 between group D and group A,B,and C(P<0.05),both of which were lower in group D than in groups A,B,and C.There was no significant difference in K31,V3,T1/2r,CL1 among the A,B,and C groups(P>0.05).The remaining pharmacokinetic parameters of the four groups were not statistically different(P>0.05).Conclusion:1.The sufentanil "Gepts" model under TCI in the degree of variability in burn patientsis is clinically acceptable.2.In severe burn patients,the plasma concentration of sufentanil decreased,the volume of deep peripheral distribution became larger,the first-order rate constant of transport from deep peripheral ventricle to central ventricle became smaller,the half-life of elimination phase was prolonged,and the total drug clearance rate decreased.In clinical work,the safety of anesthesia can be improved and the incidence of adverse reactions can be reduced by reducing drug dose or target control concentration and stopping drugs in advance after operation.