Department of Anesthesiology & Perioperative Medicine, Queen's University & Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, Canada.
Can J Anaesth. 2010 Apr;57(4):337-42. doi: 10.1007/s12630-010-9269-5. Epub 2010 Jan 29.
Drug effects can be unpredictable during cardiac surgery due to factors that may influence drug concentration, such as extracorporeal oxygenation and hemodilution. The primary aim of the current investigation was to determine whether plasma gabapentin concentration is altered by cardiopulmonary bypass (CPB).
Following approval from the Research Ethics Board and written informed consent, we conducted this open-label prospective cohort investigation. A convenience sample of 16 patients, who were scheduled for coronary bypass surgery, received oral gabapentin 600 mg as follows: 90 min prior to induction of anesthesia, following tracheal extubation, and then every eight hours for a total of four doses. Plasma gabapentin concentration, as well as pain and sedation scores, were documented.
Plasma gabapentin concentrations were unaltered during CPB (31.9 +/- 12.7 mumol.L(-1) prior to CPB, 35.6 +/- 12.9 to 37.2 +/- 9.6 mumol.L(-1) during CPB). However, using the current protocol, drug accumulation (reflected by increased drug concentrations) was observed following the third (58.2 +/- 19.5 micromol.L(-1)) and the fourth (71.9 +/- 34.3 micromol.L(-1)) doses. Pain and sedation scores and opioid requirements were comparable with those found in other studies.
Plasma gabapentin concentration is unaltered during CPB following preoperative administration. Drug accumulation following third and fourth postoperative doses suggests the need for therapeutic drug monitoring in future trials. Gabapentin is well established as an effective adjunct analgesic in a number of surgical settings. Randomized controlled trials are necessary to evaluate analgesic efficacy, optimal dosing, and adverse effects in the setting of cardiac surgery.
由于可能影响药物浓度的因素，如体外氧合和血液稀释，心脏手术期间药物的作用可能无法预测。目前研究的主要目的是确定心肺转流术（CPB）是否会改变血浆加巴喷丁浓度。
在获得研究伦理委员会的批准和书面知情同意书后，我们进行了这项开放标签前瞻性队列研究。选择 16 名计划接受冠状动脉旁路移植术的患者作为便利样本，接受口服加巴喷丁 600mg：麻醉诱导前 90 分钟、气管拔管后，然后每 8 小时一次，共 4 剂。记录了血浆加巴喷丁浓度、疼痛和镇静评分。
CPB 期间血浆加巴喷丁浓度保持不变（CPB 前为 31.9±12.7µmol·L(-1)，CPB 期间为 35.6±12.9 至 37.2±9.6µmol·L(-1)）。然而，根据目前的方案，在第三次（58.2±19.5µmol·L(-1)）和第四次（71.9±34.3µmol·L(-1)）剂量后观察到药物蓄积（反映为药物浓度增加）。疼痛和镇静评分以及阿片类药物需求与其他研究相似。
术前给予 CPB 后，血浆加巴喷丁浓度保持不变。第三和第四次术后剂量后药物蓄积表明，未来试验需要进行治疗药物监测。加巴喷丁在许多手术环境中已被确立为有效的辅助镇痛药物。需要进行随机对照试验来评估心脏手术中镇痛效果、最佳剂量和不良反应。
