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British Journal of Anaesthesia, Vol 81, Issue 6 881-886, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Metabolism of remifentanil during liver transplantation

V. U. Navapurkar, S. Archer, S. K. Gupta, K. T. Muir, N. Frazer and G. R. Park
The John Farman Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ; Department of Biochemistry, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ; Clinical Pharmacology, Glaxo Wellcome, Inc. Research Triangle Park, NC 27709, USA

We have investigated the pharmacokinetics of remifentanil and its less potent metabolite, GR90291, in six adult patients undergoing orthotopic liver transplantation (OLT). A single bolus infusion of remifentanil 10 micrograms kg-1 min-1 was given at the beginning of the dissection and anhepatic phases of OLT. Remifentanil and GR90291 concentrations were measured in subsequent serial arterial and mixed venous blood samples. Mean arterial clearance of remifentanil was significantly greater (P = 0.02) in the dissection phase (79.54 ml min-1 kg-1) than in the anhepatic phase (39.57 ml min-1 kg-1). Steady state volumes of distribution were not significantly different. Clearance of remifentanil during the anhepatic phase was similar to that of healthy adult patients. Mean maximum concentration (Cpmax) of GR90291 was lower in the dissection phase than in the anhepatic phase (P = 0.026). There was no significant pulmonary metabolism of remifentanil.
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