RESUMEN
PURPOSE: Subcutaneous fentanyl injection is commonly prescribed to manage acute pain in older patients; however, there is a gap in the literature describing the pharmacokinetic parameters for this route of administration in this population. The aim of this study was to develop and evaluate a population pharmacokinetic model for subcutaneous fentanyl injection in older patients. METHODS: Twenty-one patients who received subcutaneous fentanyl injections (50 to 75 µg) were recruited. Fentanyl concentrations were determined using a validated liquid chromatography/tandem mass spectrometry method. A population pharmacokinetic model was developed using non-linear mixed-effects modelling. A base model was selected based on the Akaike information criterion. Age, sex, body weight, number of previous fentanyl doses, number of prescribed medications, creatinine clearance, Charlson Comorbidity Index, Identification of Seniors at Risk score and concurrent use of CYP3A4 inhibitors were covariates considered for inclusion. A p value of < 0.05 was considered statistically significant for inclusion of covariates in the final model by stepwise addition. The simulation performance of the model was assessed by visual predictive check. RESULTS: A one-compartment, first-order absorption with lag time and linear elimination model was the best to fit to the fentanyl concentration data. The absorption rate constant was 0.136 h-1 (between subject variability (BSV), 46%), lag time 0.66 h (BSV 51%), apparent volume of distribution 6.28 L (BSV 30%), and apparent clearance 16.3 L.h-1 (BSV 54%). The Charlson Comorbidity Index was the only covariate included in the final model, where a higher value of the index increased fentanyl exposure and Cmax. CONCLUSION: This is the first report of subcutaneous fentanyl population pharmacokinetic model to evaluate fentanyl pharmacokinetic in older patients. The between subject variability in clearance and subcutaneous absorption rate was relatively high, and some patients recorded high fentanyl concentrations in the context of their titration to effect.
Asunto(s)
Analgésicos Opioides/farmacocinética , Fentanilo/farmacocinética , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Comorbilidad , Femenino , Fentanilo/administración & dosificación , Humanos , Inyecciones Subcutáneas , Masculino , Tasa de Depuración Metabólica , Modelos Biológicos , Absorción Subcutánea , Factores de TiempoRESUMEN
OBJECTIVES: To assess the efficiency of a short-stay unit (SSU) for undifferentiated medical patients and evaluate its effect on the overall efficiency of a general medicine department. DESIGN, SETTING AND PATIENTS: Retrospective study of all general medical patients admitted to the SSU at Flinders Medical Centre, South Australia, during its 5 years of operation (2005-2009), compared with 4 years before its institution and 2 years after its closure. MAIN OUTCOME MEASURES: Relative stay index (RSI); inhospital mortality; readmissions within 7 and 28 days. RESULTS: 23 790 general medical patients were admitted overall, and 10 764 of these (45.2%) were admitted to the SSU. The RSI for the SSU during its years of operation was 0.79, compared with 1.34 for the long-stay unit. The overall RSI for the department did not improve during those years and was not significantly different to the periods before or after. CONCLUSIONS: We found no evidence that an SSU for undifferentiated medical patients creates bed capacity. It does, however, appear to be safe.