Pharmacokinetics of fentanyl during hyperthermic, isolated lung perfusion

Background. Hyperthermic, isolated pulmonary perfusion with tumor necrosis factor is a surgical procedure that isolates the pulmonary vasculature from the systemic circulation in patients with unresectable primary or metastat ic disease confined to the chest. High drug levels are delivered to the per fused organ, avoiding systemic toxicity, and preventing loss of active drug through metabolism. Methods. The pharmacokinetics of fentanyl are evaluated in three patients w hile the operative lung is hyperthermic, ventilated, and perfused with an a sanguineous solution during nonpulsatile bypass. A loading dose of fentanyl , 1.5 mu g/kg to 2.5 mu g/kg, was given during the induction of anesthesia followed by a continuous infusion of 150 mu g/hr. Results. Results showed no difference in mean plasma fentanyl concentration s before, during, or after bypass and was consistent with clearance values previously reported in healthy adult surgical patients in the absence of an extracorporeal circuit. Conclusions. Adjustments in fentanyl dosing are not required before, during , or after hyperthermic, isolated pulmonary perfusion is established and a steady state of fentanyl is achieved.