Dosing of Opiates for Cardiopulmonary Bypass

The idea here is that complete hepatic failure if you were an hepatic during a liver transplant then you would see increased duration of action from the opiates. It doesn't take much liver function to be able to metabolize them and so relatively mild hepatic failure or hepatic impairment does not have a major impact on the opioids. Cardiopulmonary bypass reduces the plasma concentration of opioids because of a change in the volume of distribution and binding of the drug to the circuit itself. pH changes are significant as well acidosis causes decreased protein binding and therefore increased duration ofaction. If you're patient in the operating room is getting progressively acidotic you may see a longer and more potent duration of