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Pharmacokinetics of remifentanil and its major metabolite, remifentanil acid, in ICU patients with renal impairment†  Pitsiu M , Wilmer A , Bodenham A.

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Presentation on theme: "Pharmacokinetics of remifentanil and its major metabolite, remifentanil acid, in ICU patients with renal impairment†  Pitsiu M , Wilmer A , Bodenham A."— Presentation transcript:

1 Pharmacokinetics of remifentanil and its major metabolite, remifentanil acid, in ICU patients with renal impairment†  Pitsiu M , Wilmer A , Bodenham A , Breen D , Bach V , Bonde J , Kessler P , Albrecht S , Fisher G , Kirkham A   British Journal of Anaesthesia  Volume 92, Issue 4, Pages (April 2004) DOI: /bja/aeh086 Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

2 Fig 1 Graphical representation of the combined pharmacokinetic model for remifentanil and its metabolite (remifentanil acid; RA). Compartment 1 is associated with remifentanil and compartments 2 and 3 with RA. k0 is the remifentanil zero-order infusion rate, k12 and k20 the first-order elimination rate constants of remifentanil and RA, respectively, and k23 and k32 the intercompartmental rate constants for RA between compartments 2 and 3. British Journal of Anaesthesia  , DOI: ( /bja/aeh086) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

3 Fig 2 Semilogarithmic plots of individual remifentanil concentrations in the two groups: (a) normal/mild; (b) moderate/severe renal impairment. British Journal of Anaesthesia  , DOI: ( /bja/aeh086) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

4 Fig 3 Semilogarithmic plots of individual remifentanil acid concentrations in the two groups: (a) normal/mild; (b) moderate/severe renal impairment. British Journal of Anaesthesia  , DOI: ( /bja/aeh086) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

5 Fig 4 Two examples of patients’ remifentanil and remifentanil acid (RA) concentration–time profiles demonstrating biexponential decline (normal/mild renal impairment group). British Journal of Anaesthesia  , DOI: ( /bja/aeh086) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

6 Fig 5 Two examples of patients’ remifentanil and remifentanil acid (RA) concentration–time profiles demonstrating monoexponential decline (moderate/severe renal impairment group). British Journal of Anaesthesia  , DOI: ( /bja/aeh086) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

7 Fig 6 Scatter plot of remifentanil acid clearance (CLm) vs creatinine clearance (CLcr), including regression line. British Journal of Anaesthesia  , DOI: ( /bja/aeh086) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

8 Fig 7 Simulated remifentanil acid concentrations for an average individual (weight 75 kg) with (a) various degrees of renal impairment ( CLcr 0, 5, 20, 50 and 80 ml min−1) and (b) for average individual with 0 CLcr together with the patients with the highest observed remifentanil acid Cmax (Patient A, CLcr=5 ml min−1) and the highest metabolic ratio (Patient B, CLcr=0 ml min−1). British Journal of Anaesthesia  , DOI: ( /bja/aeh086) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

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