nalbuphine and Heart-Valve-Diseases

The efficacy and safety of nalbuphine hydrochloride as an IV analgesic used in combination with pretreatment and supplemental doses of diazepam with and without N2O were assessed in 15 patients scheduled to undergo aortocoronary bypass (n = 11) or valve replacement surgery (n = 4). The loading infusion of 3.0 mg/kg nalbuphine given in 20 min 5 min after conclusion of IV injection of 0.4 mg/kg/5 min diazepam caused no significant changes in systolic or diastolic systemic and pulmonary arterial blood pressures or in heart rate, cardiac index, stroke index, systemic and pulmonary vascular resistance, or right and left ventricular stroke work index. After the initial 1-hr loading infusion of 6.66 +/- 0.89 mg/kg nalbuphine (mean +/- SE), additional nalbuphine infusion maintenance doses of 4.73 +/- 0.77, 1.87 +/- 0.31, 2.16 +/- 0.23, 1.65 +/- 0.22, and 2.35 +/- 0.44 were used in the subsequent hourly periods to maintain a pain-free state throughout surgery. Hemodynamic changes during the three most stressful periods, tracheal intubation, skin incision, and sternotomy, were not statistically significant. Normal plasma catecholamine and cortisol levels indicate that these patients experienced neither stress nor pain during the maintenance of anesthesia. Nalbuphine caused no significant histamine release. All patients had uncomplicated maintenance of and emergence from anesthesia.

Topics: Adult; Aged; Analgesia; Anesthesia Recovery Period; Catecholamines; Coronary Artery Bypass; Diazepam; Double-Blind Method; Drug Administration Schedule; Female; Heart Valve Diseases; Hemodynamics; Humans; Male; Middle Aged; Morphinans; Nalbuphine; Nitrous Oxide; Pancuronium; Random Allocation

Although the hemodynamic changes produced by small doses of nalbuphine given to patients with cardiac disease are minimal, the cardiovascular effects of large doses which have been used as supplements for general anesthesia have not been investigated. Cardiovascular variables were measured after incremental doses of nalbuphine, up to 2 or 3 mg/kg in fourteen patients with coronary artery disease with normal left ventricular function and in seven patients with mitral valve disease. No significant changes in cardiac index, stroke work index, mean arterial pressure, pulmonary diastolic or wedge pressure, heart rate, or central venous pressure occurred in the preoperative period. However, nalbuphine alone did not produce surgical anesthesia and the addition of diazepam, nitrous oxide, or halothane was required in all patients. The addition of halothane coupled with surgical stimulation significantly decreased cardiac and stroke indices, increased mean arterial and pulmonary wedge pressures, and increased systemic vascular resistance in patients with coronary artery disease. In patients with mitral valve disease, following surgical incision, there were small but significant decreases in cardiac index and left ventricular stoke work index, and increases in systemic vascular resistance. Despite its lack of deleterious hemodynamic effects, the place of nalbuphine in the armamentarium of the anesthesiologist must be limited to use as a premedicant, as an adjunct to balanced anesthesia, or for postoperative pain relief.

Topics: Adult; Aged; Anesthesia, General; Coronary Artery Bypass; Coronary Disease; Female; Heart Valve Diseases; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve; Morphinans; Nalbuphine

Topics: Adult; Aged; Anesthesia; Chromatography, High Pressure Liquid; Electrochemistry; Half-Life; Heart Valve Diseases; Humans; Middle Aged; Morphinans; Nalbuphine; Naloxone; Reference Standards