buprenorphine and Coronary-Disease

The pharmacokinetic parameters of buprenorphine (BN) after a single bolus dose of 10 microg/kg i.v. was investigated in 6 male patients whose age averaged 59+/-9.8 years and body weight of 65.8+/-5.7 kg undergoing coronary artery bypass graft surgery (CABG). The unbound BN plasma concentrations were detected using ultrafiltration and high performance liquid chromatography/electro-chemical detection (HPLC/ECD) method. During cardiopulmonary bypass (CPB) there was a fall in BN plasma concentrations, observations similar to reports on fentanyl, sufentanil and alfentanil. This is probably due to haemodilution, hypothermia and hydrophobic sequestration of drug on to the CPB tubing. After CPB the concentrations rose to values higher than during CPB, though it did not attain pre CPB concentrations. These variations were not statistically significant indicating that plasma levels were adequately stable during CPB. The plasma concentration time curves were biexponential and the pharmacokinetic parameters obtained were : distribution half-life 37.24+/-6.57 min, elimination half-life 482.69+/-79 min, clearance 1221.97+/-209.42 ml/min, and volume of distribution 736.46+/-71.25 L. BN in the dose used follows the pharmacokinetic pattern of other commonly used narcotics during CABG. The mean +/- SEM plasma BN concentration during CPB was 0.51+/-0.03 ng/ml which was adequate for the maintenance of analgesia and anaesthesia, as none of our patients expressed the signs and symptoms of awareness during surgery. Further, unlike the other narcotics muscle rigidity was absent. Thus BN is a safe and good alternative to other narcotics for patients undergoing CABG.

Topics: Adult; Aged; Analgesics, Opioid; Buprenorphine; Coronary Artery Bypass; Coronary Disease; Humans; Male; Middle Aged

The analgetic effect and the side effects of buprenorphine (Temgesic) and morphine were compared in a double blind randomised study in 76 patients with suspected acute coronary heart disease. In 68 patients the acute coronary heart disease could be proven, in 61 patients the protocols could be entirely analysed. In 7 of 30 patients on buprenorphine and in 10 of 31 on morphine the analgetic effect was not sufficient (n.s.). The observed side effects were hypotension, bradycardia, nausea, vomiting, vertigo, reduction in respiratory rate and sedation. There were no significant differences in the rate of these side effects in the two groups. The average reduction in respiratory rate was more prominent in the buprenorphine group (-8 vs. -3/min. p less than 0.001) but we found no significant difference in both groups in the number of patient with a respiratory rate less than 12/min. We conclude that buprenorphine is safe for use in the pain therapy of patients with acute coronary heart disease and has a similar analgetic effect and profile of side effects as morphine. It can be used as an alternative to morphine in acute coronary heart disease.

Topics: Aged; Angina Pectoris; Buprenorphine; Clinical Trials as Topic; Coronary Disease; Double-Blind Method; Hemodynamics; Humans; Middle Aged; Morphine; Random Allocation

Kawasaki disease (KD) or mucocutaneous lymph node syndrome is an acute febrile illness affecting mainly children under four years of age. The most important clinical feature of this disease is coronary arteritis associated with aneurysms and thrombotic occlusions, which may lead to ischaemic heart disease or sudden death. It has now been more than 20 yr since its first description, and a number of survivors of childhood KD have reached child-bearing age. Despite the possible fatal outcome of this disease in adult patients with coronary artery manifestations, no information is available regarding the obstetrical anaesthetic management of patients with a history of KD. The purpose of this report is to describe the successful use of epidural anaesthesia in a patient with a history of KD undergoing Caesarean section and to discuss the anaesthetic considerations that should be given to adult survivors of childhood KD.

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthetics, Local; Bupivacaine; Buprenorphine; Cesarean Section; Coronary Aneurysm; Coronary Disease; Female; Humans; Mepivacaine; Mucocutaneous Lymph Node Syndrome; Pregnancy; Pregnancy Complications, Cardiovascular; Survivors

Fentanyl, a mu selective opioid agonist in wide clinical use, raises the ventricular fibrillation threshold in the normal canine myocardium. We have previously shown that this effect is amplified by haemorrhagic stress. In order to determine if mu receptor activation is antifibrillatory during acute myocardial ischaemia, we compared the effects of two mu selective agents, fentanyl and buprenorphine, in open chest chloralose anaesthetised dogs. Each drug was administered intravenously in two doses 1 h apart (fentanyl 30 micrograms.kg-1.dose; buprenorphine 0.3 mg.kg-1.dose). Ventricular fibrillation threshold was measured during right ventricular pacing using the single stimulus technique. The threshold was determined before and during a 10 min left anterior descending coronary artery occlusion. Prior to fentanyl administration, ventricular fibrillation threshold decreased from a control value of 19(SEM 2) mA to 12(1) mA during coronary artery occlusion. After the first dose of this drug an attenuation in the ischaemia induced fall in fibrillation threshold from 23(4) mA to 15(2) mA was observed. After the second dose of fentanyl the decline in fibrillation threshold was significantly blunted at 22(4) mA during control and 18(3) mA during occlusion, p less than 0.05 compared to no drug. In an additional series of experiments atropine sulphate abolished the antifibrillatory action of fentanyl, indicating that vagal efferent activation is responsible for the protective effect of the drug during acute myocardial ischaemia. This is in contrast with its mode of action during haemorrhage, when it enhances vagal afferent inhibition of sympathetic tone, and atropine pretreatment is without effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Buprenorphine; Coronary Disease; Dogs; Fentanyl; Heart Conduction System; Receptors, Opioid; Receptors, Opioid, mu; Ventricular Fibrillation

1. The effects of buprenorphine, given intravenously, on the incidence and severity of early acute coronary artery occlusion-induced arrhythmias were examined in anaesthetised rats. The electrophysiological effects of buprenorphine were also examined in sheep Purkinje fibres and rat papillary muscles, superfused in vitro with either a normal or a hypoxic, hyperkalaemic and acidotic physiological salt solution (PSS). 2. In anaesthetised rats subjected to acute coronary artery occlusion, pretreatment with buprenorphine (1 mg kg-1 i.v.) markedly reduced the incidence of ventricular extra-systoles during the initial 30 min post-occlusion period. The incidence of ventricular fibrillation (VF) was also significantly reduced from 56% to 10%. 3. At the antiarrhythmic dose (1 mg kg -1), buprenorphine also attenuated the sudden fall in systemic arterial blood pressure induced by acute coronary artery ligation. 4. In normal sheep Purkinje fibres and rat papillary muscles, buprenorphine (10(-6)-10(-5) M) significantly reduced the action potential height and maximum rate of depolarisation of phase zero (MRD) and prolonged the duration of the action potential. 5. Superfusion of sheep Purkinje fibres and rat papillary muscles with a hypoxic, hyperkalaemic and acidotic PSS resulted in marked reductions in resting membrane potential, upstroke and duration of the action potential. 6. In the presence of the modified compared with normal PSS, buprenorphine reduced the action potential height and MRD of both sheep Purkinje fibres and rat papillary muscles to a greater extent, although its ability to prolong the action potential duration was attenuated. 7. The antiarrhythmic effects of buprenorphine observed in vivo may be explained by its direct cardiac electrophysiological effects. Buprenorphine might be useful in relieving pain and in reducing the severity of arrhythmias in the early stages of acute myocardial infarction.

Topics: Anesthesia; Animals; Anti-Arrhythmia Agents; Blood Pressure; Buprenorphine; Coronary Disease; Coronary Vessels; Electrophysiology; Heart; In Vitro Techniques; Male; Papillary Muscles; Rats; Rats, Inbred Strains; Sheep; Time Factors

Topics: Animals; Buprenorphine; Coronary Disease; Diazepam; Dogs; Hemodynamics; Morphine