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Acetaminophen pharmacokinetics in infants and children with congenital heart disease

Jay Holladay1, Peter Winch1,2, James Morse3

  • 1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.

Paediatric Anaesthesia
|October 20, 2022
PubMed

Insights

Acetaminophen pharmacokinetics in children with congenital heart disease were similar regardless of cyanotic or acyanotic status. This study characterized acetaminophen parameters in pediatric patients following cardiac bypass surgery.

Area of Science:

  • Pediatric pharmacology
  • Cardiovascular surgery
  • Pharmacokinetics

Background:

  • Acetaminophen is a standard analgesic for children undergoing major surgery.
  • Limited data exist on acetaminophen pharmacokinetics in pediatric patients with congenital heart disease, particularly cyanotic types.

Purpose of the Study:

  • To prospectively investigate differences in acetaminophen pharmacokinetics after cardiopulmonary bypass in children with cyanotic versus acyanotic congenital heart disease.

Main Methods:

  • A prospective study included children aged 2-6 years undergoing median sternotomy for Fontan palliation (cyanotic) or two ventricle repair (acyanotic).
  • A single intravenous dose of acetaminophen (15 mg/kg) was administered post-cardiopulmonary bypass.
  • Non-linear mixed effects models were used to describe acetaminophen concentrations, with a two-compartment model with first-order elimination selected.

Main Results:

  • Data from 30 children (15 cyanotic, 15 acyanotic) yielded 208 acetaminophen concentrations.
  • A two-compartment model best described the data.
  • Population pharmacokinetic parameters, including clearance and volume of distribution, were similar between cyanotic and acyanotic groups and comparable to existing literature.

Conclusions:

  • Acetaminophen pharmacokinetics in children following cardiac bypass surgery can be described by a two-compartment model.
  • No significant differences in acetaminophen clearance or volume parameters were observed between children with cyanotic and acyanotic congenital heart disease.
Abstract

Keywords:
acetaminophencardiopulmonary bypasscongenital heart diseaseparacetamolpharmacokinetics

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