HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Sign In to gain access to subscriptions and/or personal tools.

This Article Full Text Full Text (PDF) All Versions of this Article: 0091270007299756v1 47/6/674    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Han, T. Articles by Martyn, J. A. J. Search for Related Content PubMed PubMed Citation Articles by Han, T. Articles by Martyn, J. A. J.

Fentanyl Clearance and Volume of Distribution Are Increased in Patients With Major Burns

From the Department of Anesthesia, University of Iowa Hospitals and Clinics, Carver College of Medicine, Iowa City, Iowa (Dr Han); Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Tufts–New England Medical Center, Boston, Massachusetts (Mr Harmatz, Dr Greenblatt); and Department of Anesthesiology and Critical Care, Harvard Medical School, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts (Dr Martyn).

This study examined the pharmacokinetics of fentanyl in burned patients during the hyperdynamic phase. Twenty adults, aged 37 ± 2 years (mean ± SE), with 49 ± 3% total body surface area burn, were studied at 17 ± 2 days after the injury and compared to demographically matched controls. After a 200-µg IV bolus of fentanyl, blood samples (n = 20) were collected for 4.5 hours. Concentration-time curves were fitted to a 2-compartment model. Burned patients had a higher cardiac index. Median fentanyl clearance (CL, 21.0 vs 29.4 mL/kg/min), central compartment volume (V₁, 0.37 vs 0.61 L/kg), and total volume of distribution (V_area, 3.6 vs 5.8 L/kg) were higher in burned patients. Cardiac index was unrelated to CL. The increased V₁ and V_area are likely due to large intravenous fluid replacement and tissue edema. Higher CL and larger V₁ and V_area leading to a lower fentanyl plasma concentration may partially explain the increased opiate requirement previously observed after burn injury.

Key Words: Pharmacokinetics • cardiac index • hepatic blood flow • opiates

Address for reprints: Taehyung Han, MD, PhD, FAAFP, Department of Anesthesia 5936 JPP, University of Iowa Hospitals and Clinics, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242; e-mail: anthony-han{at}uiowa.edu.