Computer-assisted continuous infusions of fentanyl during cardiac anesthesia: comparison with a manual method

Area of Science:

• Anesthesiology
• Pharmacokinetics
• Medical Informatics

Background:

• Fentanyl is a potent opioid analgesic commonly used in anesthesia.
• Achieving and maintaining stable plasma fentanyl concentrations (PFC) can be challenging with manual administration.
• Automated infusion systems offer potential for improved drug delivery precision.

Purpose of the Study:

• To develop and evaluate computer-assisted continuous infusion (CACI) systems for fentanyl administration.
• To compare the efficacy and safety of two CACI systems (stable and variable levels) against manual fentanyl infusion.
• To assess the impact of CACI on hemodynamic stability and the need for adjuvant drugs during cardiac anesthesia.

Main Methods:

• Development of two CACI systems: one for stable PFC and one for variable PFC.
• Comparison of CACI systems with manual fentanyl bolus administration in 30 patients undergoing cardiac anesthesia.
• Measurement and prediction of plasma fentanyl concentrations (PFC) to assess system accuracy.
• Evaluation of hemodynamic parameters and adjuvant drug use as outcome measures.

Main Results:

• Excellent agreement between measured and predicted PFC ratios for both CACI systems (0.99 and 1.08).
• The CACI variable fentanyl level group demonstrated superior hemodynamic stability.
• Patients receiving CACI required significantly fewer adjuvant drugs and experienced fewer hypotensive/hypertensive episodes compared to the manual group.

Conclusions:

• Computer-assisted automated infusion of fentanyl is safe and comparable to manual methods.
• CACI systems, particularly the variable level system, enhance hemodynamic stability and reduce the need for additional medications.
• CACI holds significant potential as an advanced method for intravenous anesthesia administration.