Pharmacokinetic model-driven infusion of sufentanil and midazolam during cardiac surgery: Assessment of the prospective predictive accuracy and the quality of anesthesia

Objective: To evaluate the prospective predictive accuracy and the quality of anesthesia of pharmacokinetic model-driven infusion of sufentanil and mi dazolam designed to establish and maintain a plasma level of drug during ca rdiac surgery. Design: Prospective analysis. Setting: Operating room at a university hospital. Participants: Twenty adult patients younger than 75 years old scheduled for valvular or coronary artery bypass graft surgery. Interventions: Patients were anesthetized using a variable predicted concen tration of sufentanil (1 to 10 ng/mL) combined with a stable predicted conc entration of midazolam (100 ng/mL). Measurements and Main Results: For each patient, arterial samples were take n before (6 samples), during (2 samples), and after (2 samples) cardiopulmo nary bypass (CPB). Plasma sufentanil and midazolam concentrations were meas ured by specific radioimmunoassay and highperformance liquid chromatography techniques. Predicted sufentanil and midazolam concentrations were derived using the data sets of Gepts et al and Maitre et al. The predictive perfor mance, the percentage prediction error (PE), and the absolute percentage er ror were calculated for each sample. The bias, inaccuracy, and dispersion w ere assessed by determining the median of the individual medians of the pre diction errors (MDPE), the median of the individual median of the absolute prediction errors (MDAPE), and the 10th and 90th percentiles of PE. For mid azolam, the inaccuracy was low (MDAPE < 21%), but CPB was associated with a dilution of the measured concentration associated with a negative bias. Fo r sufentanil, the inaccuracy was also low before CPB (MDAPE = 18%) but incr eased during and after CPB (MDAPE > 40%). During the whole procedure, the h emodynamic control necessitated only a few interventions. Conclusions Pharmacokinetic model-driven infusion of sufentanil and midazol am using the pharmacokinetic sets of Gepts et al and Maitre et al is a safe and accurate anesthetic technique before CPB in adult patients undergoing cardiac surgery when high sufentanil (Ito 10 ng/mL) and low midazolam (100 ng/mL) predicted plasma concentrations are targeted. Copyright (C) 2000 by W.B. Saunders Company.