Selection and rational use of analgesics in perioperative period of liver transplantation

doi:10.3877/cma.j.issn.1674-3903.2018.02.007

Abstract

Abstract:

Liver transplantation has become a routine surgery for the treatment of end-stage liver disease in modern medicine, great progress and development of surgical techniques have been made world-wide in recent years. Liver transplantation recipients have been reported to have decreased demand for opioid during perioperative period compared with patients who underwent other types of abdominal surgeries without liver disease. Preoperative liver function, process of transplantation, transient hepatic dysfunction after surgery and surgical trauma may alter the pharmacokinetic and pharmacodynamic of different analgesic. Proper medication and dosage selection can help to obtain adequate anesthetic depth and pain control, and reduce the risk of prolongation of mechanical ventilation caused by over-sedation, and is also conducive to rehabilitation of patients. This review mainly focuses on the pharmacokinetics, pharmacodynamics of commonly used analgesics in liver transplantation, and its reasonable application and safety in liver transplantation recipients, hoping to provide reference for pain management in perioperative of liver transplantation.

Key words: Liver transplantation, End-stage liver disease, Perioperative period, Liver dysfunction, Pain management, Analgesic

Yuefeng Rao, Xuan Zhang, Rongrong Wang, Zhiying Feng, Xiaoyang Lu, Weilin Wang. Selection and rational use of analgesics in perioperative period of liver transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2018, 12(02): 75-79.

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References 32

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分类	CL_H影响因素	代表药物
ER_H≥0.7	Q_H	芬太尼、舒芬太尼
0.3<ER_H<0.7	PB、酶活性、Q_H	可待因、哌替啶
ER_H≤0.3, PB<85%	酶活性	对乙酰氨基酚
ER_H≤0.3, PB≥85%	PB、酶活性	吲哚美辛

分类	CL_H影响因素	代表药物
ER_H≥0.7	Q_H	芬太尼、舒芬太尼
0.3<ER_H<0.7	PB、酶活性、Q_H	可待因、哌替啶
ER_H≤0.3, PB<85%	酶活性	对乙酰氨基酚
ER_H≤0.3, PB≥85%	PB、酶活性	吲哚美辛

药物	血浆蛋白结合率(%)	肝摄取率	消除半衰期	主要代谢途径
可待因	7.0	0.52	3.0 h	CYP2D6、葡萄糖醛酸结合
哌替啶	70.0	0.52	3.0～4.5 h	CYP2B6、CYP3A4
吗啡	30.0～40.0	0.70	2.0～4.0 h	葡萄糖醛酸结合、去甲基
氢吗啡酮	15.0	0.51	2.3 h	葡萄糖醛酸结合
羟考酮	40.0～45.0	<0.70	3.0～5.0 h	CYP2D6、CYP3A4
芬太尼	80.0～85.0	0.80	2.5～6.0 h	CYP3A4
舒芬太尼	92.5	0.70～0.90	164.0 min	CYP3A4/5
瑞芬太尼	92.0	－	3.0～10.0 min	非特异性血液和组织酯酶水解

药物	血浆蛋白结合率(%)	肝摄取率	消除半衰期	主要代谢途径
可待因	7.0	0.52	3.0 h	CYP2D6、葡萄糖醛酸结合
哌替啶	70.0	0.52	3.0～4.5 h	CYP2B6、CYP3A4
吗啡	30.0～40.0	0.70	2.0～4.0 h	葡萄糖醛酸结合、去甲基
氢吗啡酮	15.0	0.51	2.3 h	葡萄糖醛酸结合
羟考酮	40.0～45.0	<0.70	3.0～5.0 h	CYP2D6、CYP3A4
芬太尼	80.0～85.0	0.80	2.5～6.0 h	CYP3A4
舒芬太尼	92.5	0.70～0.90	164.0 min	CYP3A4/5
瑞芬太尼	92.0	－	3.0～10.0 min	非特异性血液和组织酯酶水解

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