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Abstract

Plasma levels of alpha-1-acidglycoprotein (AGP), the plasma protein primarily responsible for binding of a number of highly protein bound drugs (e.g. fentanyl, sufentanil, lidocaine, propranolol) that are frequently used during and/or immediately after cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA), were investigated in six infants undergoing surgical repair of congenital heart disease. AGP levels dropped to 32% of control values (147mg/I ± 56 versus 458mg/l ± 83; p<0.0001 ) whereas albumin and total protein levels only decreased to 47% and 41 % of prebypass values respectively. This discrepancy could be explained by the addition of albumin containing solutions to the pump prime. Since protein binding of the above mentioned drugs will be significantly decreased, with a subsequent increase in the free pharmacologically active fraction of the drugs, caution is recommended when administering these drugs during or immediately after CPB/DHCA in order to avoid side effects and toxicity.

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Alpha-1-acidglycoprotein levels in infants during cardiopulmonary bypass and deep hypothermic circulatory arrest

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