Fentanyl and Convulsions

Sebel, P.S.; Bovill, J. G.

doi:10.1213/00000539-198309000-00024

Cited by 7 publications

(3 citation statements)

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“…While a study in 1982 claimed reproducibility of this phenomenon with large doses of IV fentanyl (1000 to 1500J.Lg as a bolus resulting in plasma fentanyl concentrations above 600 J.Lg/L) [Rao et al 1982], this was immediately disputed by Sebel and Bovill (1983), who could not find clinical or electroencephalogram (EEG) evidence of convulsive activity and claimed that unmodified muscle rigidity might be an explanation for the convulsive-type movements de-205 scribed. An examination of electromyograms (EMGs) and EEGs of 127 patients anaesthetised with large doses of opioids revealed clinical and EMG manifestation of rigidity sometimes resembling seizures in over 50%, while the EEG showed no evidence of seizure activity.…”

Section: Rigiditymentioning

confidence: 99%

Adverse Effects of Systemic Opioid Analgesics

Schug¹,

Zech²,

Grond³

1992

Drug Safety

142

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Adverse effects of opioids are multiple. They are most often receptor-mediated and inseparable from their desired effects. The most severe mishaps with opioids are related to their respiratory depressant effect, which is widely influenced by factors such as pain, previous opioid experience and awareness. Other relevant central nervous system effects of opioids include cough suppression, nausea and vomiting, rigidity, pruritus and miosis. The cardiovascular adverse effects of opioids are mainly related to histamine release and differ widely between agonists and agonist-antagonists. Gastrointestinal effects such as constipation, reflux and spasms of the bile duct are well described. Adverse effects on endocrine, immunological and haematological functions are possible, while allergic reactions are extremely rare. The adverse effects of long term use are overestimated. Systemic toxicity is negligible and development of tolerance is minimal while treating pain. In the clinical setting of pain control, addiction and withdrawal do not pose significant problems. Nevertheless, the possible effects of opioids on the unborn child should always be considered. Overall, opioids show a good record of safety. Their use should not be unduly limited by unfounded fears of adverse effects, but these effects should be avoided by anticipation and prevention.

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Section: Rigiditymentioning

confidence: 99%

Adverse Effects of Systemic Opioid Analgesics

Schug¹,

Zech²,

Grond³

1992

Drug Safety

142

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“…Recent case reports, unaccompanied by EEG recordings, of fentanyl-or sufentanil-induced seizures in patients have generated much discussion and concern (Brian & Seifen 1987;Katz et al 1988;Rao et al 1982;Safwat & Daniel 1983;Sebel & Bovill 1983); seizures have in fact been associated with both low and high doses of these opioid agents. Murkin et al (1984) found that a very high peak plasma fentanyl concentration, and moderately high but sustained fentanyl concentrations, were not associated in humans with EEG signs of seizure activity or cortical excitation.…”

Section: Fentanyl and Sufentanilmentioning

confidence: 99%

“…In some cases the successful use of small doses of nondepolarising muscle relaxants to control such seizures has led to the conclusion that these phenomena can represent an exaggerated form of narcotic-induced muscle rigidity (Benthuysen & Stanley 1985). Another possibility is that this reaction is a form of myoclonus secondary to narcotic-induced depression of inhibitory neurons; however, if the significant number of cases in which this seizure-like activity has been linked to fentanyl or sufentanil administration are taken into account, an unknown, idiosyncratic mechanism for this reaction should be ruled out (Katz et al 1988;Scott & Sarnquist 1985;Sebel & Bovill 1983).…”

Section: Fentanyl and Sufentanilmentioning

confidence: 99%

Clinical Features, Pathogenesis and Management of Drug-Induced Seizures

1990

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Many classes of pharmacological agents have been implicated in cases of drug-induced seizures. The list includes antidepressant drugs, lithium salts, neuroleptics, antihistamines (H1-receptor antagonists), anticonvulsants, central nervous system stimulants, general and local anaesthetics, antiarrhythmic drugs, narcotic and non-narcotic analgesics, non-steroidal anti-inflammatory drugs, antimicrobial agents, antifungal agents, antimalarial drugs, antineoplastic drugs, immunosuppressive drugs, radiological contrast agents and vaccines. For each of these classes of drugs, this article offers a revision of the literature and emphasises in particular the frequency of the adverse reaction, its clinical presentation, its presumed epileptogenic mechanism and the therapeutic strategy for the management of drug-induced seizures. An attempt is also made to distinguish seizures induced by standard dosages from those provoked by accidental or self-induced intoxication. For some classes of drugs such as antidepressants, neuroleptics, central nervous system stimulants (e.g. theophylline, cocaine, amphetamines) and beta-lactam antibiotics, seizures are a well recognised adverse reaction, and a large body of literature has been published discussing exhaustively the major aspects of the issue; sufficient data are available also for the other classes of pharmacological agents mentioned above. In contrast, several other drugs [e.g. allopurinol, digoxin, cimetidine, protirelin (thyrotrophin releasing hormone), bromocriptine, domperidone, insulin, fenformin, penicillamine, probenecid, verapamil, methyldopa] have not been studied thoroughly under this aspect, and the only source of information is the occasional case report. This review does not address the issue of seizures induced by drug withdrawal.

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Analgesics

Cold¹,

Dahl²

2002

Topics in Neuroanaesthesia and Neurointensive Care

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Fentanyl and Convulsions

Cited by 7 publications

References 0 publications

Adverse Effects of Systemic Opioid Analgesics

Adverse Effects of Systemic Opioid Analgesics

Clinical Features, Pathogenesis and Management of Drug-Induced Seizures

Analgesics

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