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RESUMEN
Con la aparición de nuevos medicamentos opioides en el mercado de los fármacos anestésicos, podríamos pensar que disponemos de moléculas capaces de reemplazar al legendario fentanilo. Sin embargo, el estudio de sus propiedades farmacocinéticas y farmacodinámicas, nos permite utilizarlo de una manera adecuada, aprovechando su potencia, su excelente analgesia y su seguridad, comparable esta última con los demás opioides cuando se administra con la guía de modelos farmacocinéticos.
Para esto, es necesario tener en cuenta que varios de los medicamentos utilizados con frecuencia durante el acto anestésico (midazolam, dexametasona, prednisolona, ketamina, etc.), pueden influenciar su metabolismo por la enzima citocromo P4503A4.
El conocimiento y la aplicación juiciosa de los modelos farmacocinéticos nos permiten estimar las concentraciones plasmáticas, de modo que nos brinde las mejores condiciones analgésicas, asociadas a un destacado sinergismo con los hipnóticos de uso frecuente, como el propofol y el desfluorano. Su aprovechamiento es máximo cuando se utiliza con una indicación específica, como en cirugía prolongada (mayor de 120 minutos) o que represente un estímulo de percepción del dolor importante para el paciente.
Palabras clave:
fentanilo
farmacocinética
farmacología
nomogramas
anestesia intravenosa (Fuente: DeCS, Bireme)
ABSTRACT
With the advent of the new opioids in the anesthetic drug market, we may think that we have molecules available to replace the legendary fentanyl. However, studying its pharmacodynamic and pharmacokinetic properties, fentanyl can still be appropriately used to take advantage of its excellent analgesia and safety, comparable to that of other opioids when administered in accordance with pharmacokinetic models.
We must not forget however that several drugs frequently used during anesthesia (midazolam, dexametasone, prednisolone, ketamin, etc.), may impact the metabolism of fentanyl on account of the cytochrome P450 3A4 enzyme.
The knowledge and judicious application of pharmacokinetic models serve to estimate plasma concentrations in order to ensure the best analgesic conditions associated to synergies with the frequent use of hypnotics such as propofol and desfluorane. Fentanyl is best used for specific indications such as extended surgical procedures (over 120 minutes) or procedures that stimulate the patient's pain perception.
Key words:
fentanyl
pharmacokinetics
pharmacology
nomograms
intravenous anesthesia (Source: MeSH, NLM)
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