Delayed Muscular Rigidity and Respiratory Depression Following Fentanyl Anesthesia

P Pu ur rp po os se e: : To present and discuss a case of opioid-induced rigidity with low-dose fentanyl during recovery from anesthesia.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 41-yr-old woman underwent laparotomy for total abdominal hysterectomy and bilateral salpingo-oophorectomy under general anesthesia. She received a total of 500 µg of fentanyl by iv intermittent boluses during the three-hour anesthetic. During emergence from anesthesia, while intubated, the patient presented with rigidity. No changes in ventilatory parameters were measured during the episode. The only notable predisposing factor was treatment with venlafexine, an antidepressant that modifies serotonin and norepinephrine levels. She was successfully treated with iv naloxone 20 µg. The rest of the postoperative period was uneventful.

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“…16 Signs vary based on the time elapsed after the administration of the opioid. At induction, the dominant finding is rigidity.…”

Section: Pathophysiology Of Opioid-induced Rigiditymentioning

confidence: 99%

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Roy

Fortier

2003

Can J Anesth/J Can Anesth

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“…141 Thiopental may produce parkinsonian symptoms 142 ; however there is no clear evidence supporting this effect. Fentanyl can cause muscle rigidity 132 and Morphine can cause akinesia at higher doses in patients with PD. 143 Pain International association for the study of pain define pain as an unpleasant sensory and emotional experience associated with actual and potential tissue damage or described in terms of such damage.…”

Section: Anesthetic Agentsmentioning

confidence: 99%

Dementia With Lew Body

Pervin

Edwards

Lippa

2015

Am J Alzheimers Dis Other Demen

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Patients who have dementia with Lewy bodies (DLB) and undergo surgery may develop aggravated postoperative cognitive dysfunction or postoperative delirium. Many patients with DLB respond poorly to surgery and anesthesia, and their conditions may worsen if they have other medical complications along with dementia. They may also face high risk of prolonged hospital stay, increased medical problems and/or mortality, causing significant physical, psychosocial, and financial burdens on individuals, family members, and society. Anesthesia, pain medications, old age, and surgery-related stresses are usually held responsible for the complications; however, the exact causes are still not fully understood. Literature on surgery-related complications for patients with DLB appears to be inadequate, and hence the topic merits detailed and systematic research. This article reviews postoperative complications and various surgery-related risk factors for DLB in light of other dementias such as Alzheimer's disease, as their neuropathologic features overlap with those of DLB.

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“…In der postoperativen Schmerztherapie sollten bevorzugt nichtsteroidale Analgetika (Paracetamol, Ibuprofen oder Metamizol) eingesetzt werden, da Opioide Muskelrigidität begünstigen können [47,48]. Pethidin und Tramadol dürfen nicht mit Selegilin oder Rasagilin (Azilect®) kombiniert werden, da schwerwiegende Komplikationen bei Komedikation von Pethidin und Selegilin beschrieben wurden ( [16]; Fachinformationen).…”

Section: Postoperative Phaseunclassified

“…Zwar wurde mehrfach über Fentanyl berichtet, aber dieses Phänomen ist sicher nicht substanzspezifisch [47,50]. Die klinische Anwendung zeigt, dass alle Opioide Rigor oder "Thoraxsteife" auslösen können.…”

Section: Medikamente Und Wechselwirkungenunclassified

Morbus Parkinson

Wüllner

Standop²,

Kaut³

et al. 2012

Anaesthesist

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Approximately 10,000-15,000 Parkinson's disease (PD) patients per year undergo surgery in Germany. The demographic developments along with further surgical progress and procedural refinements will lead to increasing numbers of PD patients in the operating theatre (OR). There are several perioperative risk factors for PD patients, they more often require prolonged intensive care treatment and warrant particular anesthesiological attention with regard to the choice of drugs and equipment. Careful evaluation of concomitant diseases, maintenance of oral Parkinson therapeutic drugs up to the time of surgery and continuous perioperative dopaminergic therapy are key factors for reducing postoperative morbidity in PD patients undergoing surgery.

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Delayed Muscular Rigidity and Respiratory Depression Following Fentanyl Anesthesia

Cited by 51 publications

References 6 publications

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Dementia With Lew Body

Morbus Parkinson

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