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Decreased protein binding of alfentanil in plasma from children with kidney or liver failure
Author(s) -
DAVIS P.J.,
STILLER R.L.,
McGOWAN F.X.,
CHAKRAVORTI S.,
COOK D.R.
Publication year - 1993
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.1993.tb00028.x
Subject(s) - medicine , albumin , liver disease , alfentanil , liver transplantation , serum albumin , kidney , endocrinology , kidney disease , pharmacokinetics , gastroenterology , pharmacology , transplantation , propofol
Summary Disease states, including end‐stage kidney or liver failure, can alter the protein binding of various drugs in children. The plasma protein binding of alfentanil was evaluated in blood samples from 15 children about to undergo kidney transplantation, 21 children undergoing liver transplantation, and 28 otherwise healthy children undergoing elective surgery. Compared with the healthy children, patients with kidney disease had a significant decrease in protein binding (89.2%± 5.4 v. 93.1%± 3.2), an increase in α 1 ‐acid glycoprotein concentration (108.8 mg·dl −1 ± 44.3 v. 71.8 mg·dl −1 ± 30.7), and no change in albumin concentration (3910 mg·dl −1 ± 754 v. 4555 mg·dl −1 ± 524); whereas patients with liver disease had a significant decrease in protein binding (85.9%± 6.2 v. 93.1%± 3.2), no change in α 1 ‐acid glycoprotein concentration (65.8 mg·dl −1 ± 31.8 v. 71.8 mg·dl ± 30.7), and a decrease in albumin concentration (3045 mg·dl −1 ± 1255 v. 4555 mg·dl −1 ± 524). Because alfentanil is highly protein bound, even small changes in the drug's free fraction could have marked pharmacodynamic effects in patients with kidney or liver failure.