Acute neuropsychiatric findings in a patient receiving fentanyl for cancer pain

Bruera, Éduardo; Pereira, João Pablo Fortes

doi:10.1016/s0304-3959(96)03238-1

Cited by 35 publications

(32 citation statements)

References 1 publication

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“…Fisher [7,8] described two cases of visual hallucinations on eye closure attributed to atropine toxicity and lidocaine as the local anesthetic for minor surgery. In our patient, hydrocortisone, fentanyl, ephedrine, and midazolam, along with atropine and lidocaine could be candidate hallucinogens [9][10][11][12], although the doses were not excessive. Microembolic insult to the pulmonary circulation resulting in cerebral hypoxic damage and/or direct damage to the visual association cortex may cause visual hallucinations on eye closure [3].…”

Section: Discussionmentioning

confidence: 68%

Visual hallucinations on eye closure after orthopedic surgery under general anesthesia

Otomo

Sugita

Yano³

2008

J Anesth

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A 61-year-old woman suffering from rheumatoid arthritis without a contributory neurological, mental, or psychological history experienced visual hallucinations solely on eye closure after total hip arthroplasty under general anesthesia combined with epidural anesthesia. The visual hallucinations first appeared when she arose from sleep early on postoperative day 1, approximately 12 h after the end of surgery. Only on closing her eyes, she had a clear view of colored clothes, lace curtains, handbags, hats, and sofas, all of which were vivid, realistic, complex, of natural size, and in normal perspective without distortion and appeared independently and randomly in succession. The hallucinations disappeared when she opened her eyes even in the dark. The visual hallucinations gradually decreased as the days elapsed and they had entirely subsided on postoperative day 4. The level and content of her consciousness seemed entirely normal throughout her hospital course. Although postoperative visual hallucinations are not uncommon, they do not always show the closed-eye variation. The causes and underlying mechanisms of this type of visual hallucination remain to be elucidated.

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Section: Discussionmentioning

confidence: 68%

Visual hallucinations on eye closure after orthopedic surgery under general anesthesia

Otomo

Sugita

Yano³

2008

J Anesth

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“…The rationale of switching opioid (opioid rotation) in the context of opioid-related delirium is that the potentially toxic metabolites from the prior opioid are eliminated when a switch is made to a new opioid [28,72]. However, opioid-induced delirium is not exclusively due to metabolite accumulation: cases of opioid toxicity have been reported in relation to fentanyl and methadone, neither of which is known to have active metabolites [12,104]. Hence, the potential accumulation of parent opioid or possibly unknown metabolites also needs to be considered in the pathogenesis of opioid-related delirium.…”

Section: Fluid Deficit State: Pathophysiology and Pathogenesismentioning

confidence: 99%

Delirium and dehydration: some fluid for thought?

Lawlor

2002

Support Care Cancer

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Delirium is a frequent complication of advanced cancer. It is characterized by cognitive deficits and behavioral disturbance, and therefore can potentially result in severe symptom distress and impeded communication between patient and family and between patient and medical staff. The reversibility of delirium depends on its underlying causes. Delirium is multifactorial in origin, and precipitating or contributory factors include dehydration and hypovolemia. Much of the debate concerning the role of hydration in advanced cancer has centered on symptoms such as thirst, and ethical issues such as parenteral hydration and its association with prolongation of life, with the association between hydration status and delirium largely excluded. This review examines the latter association in the light of recent studies. It also provides an outline of relevant pathophysiology and clinical assessment, a decision-making framework and a practical approach to the techniques of assisting hydration. This will hopefully help physicians and families in weighing up the merits of assisted hydration in an individual context and help them to achieve a consensus on the role of hydration that is consistent with the goals of care.

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“…Solche auch unter eskalierenden Dosen von transdermalem Fentanyl auftretenden pronozizeptiven Effekte [9] scheinen beim Opioid Buprenorphin, selbst wenn es wie im vorliegenden Fall in extrem hohen Dosierungen eingesetzt wird, nicht vorzuliegen. Eine solche Annahme kann aus experimentell am Menschen gewonnenen Daten abgeleitet werden, denn ein hyperalgetischer Effekt, wie er bei wachen Probanden für Fentanyl und Alfentanil typisch ist, konnte bei Buprenorphin nicht nachgewiesen werden [26].…”

Section: Pronozizeptive Effekteunclassified

Hochdosis-Buprenorphin im Rahmen der ambulant-palliativen Schmerztherapie

Gastmeier

Freye

2008

Schmerz

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The case of a 78-year-old patient with cancer-related pain and additionally mixed-pain syndrome is presented. Pain therapy with buprenorphine TTS 210 microg/h every 3 days was sufficient in the beginning, later the therapy was changed because of increasing problems of tape fixing during fever periods under chemotherapy to a continuous infusion of buprenorphine intravenously via an external medication pump. During the course of therapy it became necessary to increase the dose to 99.9 mg/day buprenorphine. Under this medication a sufficient pain reduction (median NRS 2-3) over a period of 135 days could be achieved. At the same time the patient was vigilant and cooperative without signs of intoxication until the end of life at home in the presence of his family.If no signs of intoxication occur under extreme opioid therapy and a sufficient pain therapy can be achieved, a rotation to another opioid is not necessary. However, outpatient palliative care requires a frequent adaptation to the individually varying opioid demand of the patient and time-consuming nursing care.

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Acute neuropsychiatric findings in a patient receiving fentanyl for cancer pain

Cited by 35 publications

References 1 publication

Visual hallucinations on eye closure after orthopedic surgery under general anesthesia

Visual hallucinations on eye closure after orthopedic surgery under general anesthesia

Delirium and dehydration: some fluid for thought?

Hochdosis-Buprenorphin im Rahmen der ambulant-palliativen Schmerztherapie

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