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Population Pharmacokinetic Modeling of Remifentanil in Infants with Unrepaired Tetralogy of Fallot

Jing Chang1,2, Yang Shen1,2, Yue Huang1,2

  • 1Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Shanghai, 200127, China.

European Journal of Drug Metabolism and Pharmacokinetics
|June 20, 2018
PubMed

Insights

Tetralogy of Fallot (TOF) does not alter remifentanil pharmacokinetics in infants. This suggests similar anesthetic dosing for infants with TOF and those with normal cardiac anatomy.

Area of Science:

  • Anesthesiology
  • Pediatric Cardiology
  • Pharmacokinetics

Background:

  • Congenital heart disease can alter anesthetic pharmacokinetics in children.
  • Limited data exists on remifentanil pharmacokinetics in infants with unrepaired Tetralogy of Fallot (TOF).

Purpose of the Study:

  • Characterize remifentanil population pharmacokinetics in infants.
  • Evaluate the impact of unrepaired TOF on remifentanil pharmacokinetics.

Main Methods:

  • Twenty-seven infants (114-360 days) were studied: 16 with TOF, 11 with normal cardiac anatomy.
  • Remifentanil (1 μg/kg/min IV) was administered for anesthesia induction and maintenance.
  • Population pharmacokinetics were analyzed using NONMEM, with estimates standardized to a 70-kg adult.

Main Results:

  • A two-compartment model adequately described remifentanil pharmacokinetics.
  • TOF status did not significantly impact the pharmacokinetic model (P > 0.05).
  • Population parameter estimates for clearance and volume of distribution were derived, normalized by body weight.

Conclusions:

  • Unrepaired TOF does not alter remifentanil pharmacokinetics in infants.
  • Similar remifentanil dosing is suggested for infants with and without TOF.
Abstract

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