Population pharmacokinetics of nalbuphine after surgery in children.

BACKGROUND: Nalbuphine is an opioid analgesic agent widely used for control of mild-to-severe pain. However, limited data are available on the pharmacokinetics of this drug in children. The aim of this study was to characterize the population pharmacokinetics of nalbuphine in patients with ages ranging from 1 to 11 yr and to identify patient characteristics partially explaining inter-individual variability in nalbuphine pharmacokinetic parameters. METHODS: Twenty-two children were included in this study. They received nalbuphine after surgery by continuous infusion (loading dose, 0.2 mg kg(-1) over 10 min followed by continuous infusion of 0.8 mg kg(-1) over 24 h). If pain relief was not adequate, 0.1 mg kg(-1) bolus doses were allowed in 10 min. Eleven blood samples were collected per patient. The data were analysed by non-linear mixed-effect modelling with the use of a two-compartment structural model. RESULTS: Twenty patients completed the study. In the final model, the parameter values were standardized for a body weight of 70 kg using an allometric model. Population parameter estimates were: clearance 130 litre h(-1) 70 kg(-1), inter-compartment clearance 75.6 litre h(-1) 70 kg(-1), central volume of distribution 210 litre 70 kg(-1), and peripheral volume of distribution 151 litre 70 kg(-1). In the children of this study, total clearance expressed in litre h(-1) kg(-1) decreased significantly with increasing age and the elimination half-life significantly increased. CONCLUSIONS: The allometric power model developed in this study best reflected the data and may be useful for dose adjustment.

Population pharmacokinetics of the two enantiomers of tramadol and O-demethyl tramadol after surgery in children.

BACKGROUND: Few data are available on the stereoselective pharmacokinetics of tramadol in children. The aim of this study was to develop a population pharmacokinetic model for the (+)- and (-)-enantiomers of tramadol and its O-demethyl tramadol metabolite (M1) in children. METHODS: Twenty-five children (1-8 yr) were included in this study. Tramadol was administered after surgery by continuous infusion (loading dose, 2 mg kg(-1) i.v. over 10 min followed by continuous infusion of 8 mg kg(-1) over 24 h). If pain relief was inadequate, additional 1 mg kg(-1) i.v. bolus doses of tramadol were given over 10 min. A two-compartment structural model was used with NONMEM. RESULTS: For both enantiomers of tramadol, weight was the only patient characteristic parameter showing significant covariate effects on clearance (CL). CL increased by 5.7-6.1 litre h(-1) between 8-12 and 13-16 kg, and by 2.4-3.3 litre h(-1) between 13-16 and 17-33 kg. The rate constants associated with the metabolite elimination [0.144 h(-1), (+)-M1 and 0.18 h(-1), (-)-M1] were smaller than the elimination rate constants of the parent drugs [0.243 h(-1), (+)-tramadol and 0.241 h(-1), (-)-tramadol], suggesting that the metabolite disposition was rate-limited by its elimination. The presence of two subpopulations of patients was suspected on the basis of the observed bimodal distributions of the AUC(M1)/AUC(tramadol) ratios. CONCLUSIONS: The results of this study combine relationships between tramadol CL and patient covariates that may be useful for dose adjustment. Polymorphism is likely to contribute to the interpatient variability observed in the AUC M1/AUC tramadol ratios.

Bending properties of superelastic and nonsuperelastic nickel-titanium orthodontic wires.

Cantilever bending properties were evaluated for several clinically popular sizes of three superelastic and three nonsuperelastic brands of nickel-titanium orthodontic wires in the as-received condition, and for 0.016-inch diameter wires after heat treatment at 500 degrees and at 600 degrees C, for 10 minutes and for 2 hours. A torque meter apparatus was used for the bending experiments, and the specimen test-span length was 1/4 inch (6 mm). In general, the bending properties were similar for the three brands of superelastic wires and for the three brands of nonsuperelastic wires. For the three brands of superelastic wires, heat treatment at 500 degrees C for 10 minutes had minimal effect on the bending plots, whereas heat treatment at 500 degrees C for 2 hours caused decreases in the average superelastic bending moment during deactivation; heat treatment at 600 degrees C resulted in loss of superelasticity. The bending properties for the three brands of nonsuperelastic wires were only slightly affected by these heat treatments. The differences in the bending properties and heat treatment responses are attributed to the relative proportions of the austenitic and martensitic forms of nickel-titanium alloy (NiTi) in the microstructures of the wire alloys.

Structure and mechanical properties of as-received and heat-treated stainless steel orthodontic wires.

A combination of x-ray diffraction analysis with mechanical testing in tension and bending has been used to investigate the metallurgical structures and mechanical properties for as-received and heat-treated stainless steel orthodontic wires. Two different proprietary wire types were selected, having a wide range in cross-sectional dimensions: 0.016-, 0.030-, and 0.050- or 0.051-inch diameters, and 0.017 X 0.025-inch rectangular specimens. Heat treatments were performed for 10 minutes in air at temperatures of 700 degrees, 900 degrees, and 1100 degrees F. The x-ray diffraction patterns showed that the as-received 0.016-inch diameter and 0.017 X 0.025-inch wires of both proprietary types consisted of a two-phase structure containing a martensitic phase along with the austenitic phase. This duplex structure was converted entirely to austenite with heat treatment for one wire type, but persisted after heat treatment for the other wire type. The largest diameter, 0.050- or 0.051-inch, wires of both types were single-phase austenitic structure for both the as-received and heat-treated conditions. Evidence of substantial preferred crystallographic orientation or texturing in these orthodontic wires was also found by x-ray diffraction. As in our previous studies, the modulus of elasticity in bending was significantly less than the value obtained in tension for only the smaller cross-sectional wires. The 0.05 radian flexural yield strength correlated more closely with the 0.2% offset yield strength in tension than with the yield strength for 0.05% and 0.1% permanent offsets.