Leuschen M P, Willett L D, Hoie E B, Bolam D L, Bussey M E, Goodrich P D, Zach T L, Nelson R M
Department of Pediatrics, Creighton University University of Nebraska Medical Center, Omaha.
J Thorac Cardiovasc Surg. 1993 May;105(5):885-91.
Plasma levels of fentanyl were analyzed in 12 infants undergoing extracorporeal membrane oxygenation who received a fentanyl bolus (5 to 10 micrograms/kg) followed by infusion at 1 to 6.3 micrograms/kg/hr. Fentanyl levels, averaging 11 samples/infant, were measured by radioimmunoassay (mean 19.7 +/- 35.7 ng/ml; n = 140). Eight of the infants, all with a primary diagnosis other than congenital diaphragmatic hernia, survived with relatively short (< 7 days) courses on extracorporeal membrane oxygenation; this group of infants did not develop tolerance to fentanyl and could be maintained on infusion rates of < 5 micrograms/kg/hr throughout. The four infants with congenital diaphragmatic hernia had longer extracorporeal membrane oxygenation runs and three did not survive; their plasma fentanyl levels were consistently higher and while the infusion rates were higher early on extracorporeal membrane oxygenation, they did not exceed 7 micrograms/kg/hr and actually decreased after 5 days on extracorporeal membrane oxygenation. Five infants (42%) received lorazepam in addition to fentanyl for at least one sampling time. The fentanyl infusion dose and plasma level were higher in the congenital diaphragmatic hernia nonsurvivors who did not receive lorazepam (p < 0.001). A decrease in fentanyl clearance correlated with renal dysfunction (p < 0.01). A bolus of fentanyl followed by infusion of relatively low doses (1 to 5 micrograms/kg/hr) provides adequate analgesia for infants on extracorporeal membrane oxygenation, particularly when it is supplemented with intravenous lorazepam whenever needed to control infant movement.
对12例接受体外膜肺氧合的婴儿的血浆芬太尼水平进行了分析，这些婴儿先接受了芬太尼推注（5至10微克/千克），随后以1至6.3微克/千克/小时的速度输注。芬太尼水平通过放射免疫测定法测量，平均每个婴儿检测11个样本（平均19.7±35.7纳克/毫升；n = 140）。其中8例婴儿，其主要诊断均不是先天性膈疝，在相对较短（<7天）的体外膜肺氧合疗程后存活；这组婴儿未对芬太尼产生耐受性，在整个过程中可维持<5微克/千克/小时的输注速度。4例患有先天性膈疝的婴儿进行体外膜肺氧合的时间更长，其中3例未存活；他们的血浆芬太尼水平一直较高，虽然在体外膜肺氧合早期输注速度较高，但未超过7微克/千克/小时，且在体外膜肺氧合5天后实际有所下降。5例婴儿（42%）在至少一个采样时间除芬太尼外还接受了劳拉西泮。未接受劳拉西泮的先天性膈疝非存活者的芬太尼输注剂量和血浆水平更高（p < 0.001）。芬太尼清除率的降低与肾功能障碍相关（p < 0.01）。先推注芬太尼然后输注相对低剂量（1至5微克/千克/小时）可为接受体外膜肺氧合的婴儿提供足够的镇痛效果，特别是在必要时补充静脉注射劳拉西泮以控制婴儿活动时。
