Glottic Closure Following Large Doses of Fentanyl

Arandia, Hernando Y.; Patil, Vijayalakshmi U.

doi:10.1097/00000542-198704000-00030

Cited by 46 publications

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“…Side effects involving respiration are well known and include depression of tidal volume and gas exchange, slowed rate of breathing progressing to respiratory arrest with higher doses, and blunting of respiratory sensitivity to carbon dioxide (32,56,63). In the surgical theater, additional respiratory side effects of opioids are airway obstruction at glottic and supraglottic levels, decreased chest wall compliance, and increased resting tension of abdominal musculature (1,3,7,8,13,43,47,54). Although these impediments to ventilation are potentially life threatening and occur not infrequently, the sites and mechanisms within the respiratory neural network that give rise to them have not been investigated in detail.…”

mentioning

confidence: 99%

μ-Opioid receptor agonist effects on medullary respiratory neurons in the cat: evidence for involvement in certain types of ventilatory disturbances

Lalley

2003

American Journal of Physiology-Regulatory, Integrative and Comp

123

133

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Mu-opioid receptor agonists depress tidal volume, decrease chest wall compliance, and increase upper airway resistance. In this study, potential neuronal sites and mechanisms responsible for the disturbances were investigated, dose-response relationships were established, and it was determined whether general anesthesia plays a role. Effects of micro-opioid agonists on membrane properties and discharges of respiratory bulbospinal, vagal, and propriobulbar neurons and phrenic nerve activity were measured in pentobarbital-anesthetized and unanesthetized decerebrate cats. In all types of respiratory neurons tested, threshold intravenous doses of the micro-opioid agonist fentanyl slowed discharge frequency and prolonged duration without altering peak discharge intensity. Larger doses postsynaptically depressed discharges of inspiratory bulbospinal and inspiratory propriobulbar neurons that might account for depression of tidal volume. Iontophoresis of the micro-opioid agonist DAMGO also depressed the intensity of inspiratory bulbospinal neuron discharges. Fentanyl given intravenously prolonged discharges leading to tonic firing of bulbospinal expiratory neurons in association with reduced hyperpolarizing synaptic drive potentials, perhaps explaining decreased inspiratory phase chest wall compliance. Lowest effective doses of fentanyl had similar effects on vagal postinspiratory (laryngeal adductor) motoneurons, whereas in vagal laryngeal abductor and pharyngeal constrictor motoneurons, depression of depolarizing synaptic drive potentials led to sparse, very-low-frequency discharges. Such effects on three types of vagal motoneurons might explain tonic vocal fold closure and pharyngeal obstruction of airflow. Measurements of membrane potential and input resistance suggest the effects on bulbospinal Aug-E neurons and vagal motoneurons are mediated presynaptically. Opioid effects on the respiratory neurons were similar in anesthetized and decerebrate preparations.

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confidence: 99%

μ-Opioid receptor agonist effects on medullary respiratory neurons in the cat: evidence for involvement in certain types of ventilatory disturbances

Lalley

2003

American Journal of Physiology-Regulatory, Integrative and Comp

123

133

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“…Laryngospasm in the non-paralysed patient can be an important factor in failure of mask ventilation. Use of narcotic anaesthesia without paralysis may cause ventilation difficulty with the likely mechanism being vocal cord closure [17,18].…”

Section: Incidence and Causation Of Cicomentioning

confidence: 99%

Equipment and strategies for emergency tracheal access in the adult patient

Hamaekers

Henderson

2011

Anaesthesia

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SummaryThe inability to maintain oxygenation by non‐invasive means is one of the most pressing emergencies in anaesthesia and emergency care. To prevent hypoxic brain damage and death in a ‘cannot intubate, cannot oxygenate’ situation, emergency percutaneous airway access must be performed immediately. Even though this emergency is rare, every anaesthetist should be capable of performing an emergency percutaneous airway as the situation may arise unexpectedly. Clear knowledge of the anatomy and the insertion technique, and repeated skill training are essential to ensure completion of this procedure rapidly and successfully. Various techniques have been described for emergency oxygenation and several commercial emergency cricothyroidotomy sets are available. There is, however, no consensus on the best technique or device. As each has its limitations, it is recommended that all anaesthetists are skilled in more than one technique of emergency percutaneous airway. Avoiding delay in initiating rescue techniques is at least as important as choice of device in determining outcome.

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“…Difficult or impossible ventilation after opioid induction is commonly ascribed to rigidity of the abdominal and thoracic musculature. There has been some evidence that fiber optic visualization of the glottis revealed closed vocal cords in some; however, they also described patients who had opened vocal cords but could not be ventilated [28]. The incidence of rigidity and severities varies depending on the kinds of opioid and doses used and the rate at which it is administered.…”

Section: Discussionmentioning

confidence: 99%

The proper effect site concentration of remifentanil for prevention of myoclonus after etomidate injection

Shin

Kim

et al. 2011

Korean J Anesthesiol

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BackgroundEtomidate frequently induces myoclonus when administered intravenously with bolus injection during anesthetic induction. This can be bothersome for the anesthesiologist. The dose of remifentanil appropriate for preventing myoclonus without side effects was investigated.MethodsAll patients with American Society of Anesthesiologists (ASA) physical status I-III were divided into three groups (n = 33 per group) according to the pretreatment effect site concentration of remifentanil (Ultiva, Glaxo-Wellcome, München, Germany) of 0, 2 or 4 ng/ml (Group N: 0 ng/ml, Group R: 2 ng/ml, Group Q: 4 ng/ml) by a target controlled infusion (TCI) system. After a 0.3 mg/kg dose of etomidate was injected intravenously for over 1 minute for anesthetic induction, myoclonus was observed. Before the etomidate injection, the patients were pretreated with remifentanil and their side effects were monitored.ResultsThe number of patients showing myoclonus was significantly different among the groups. The incidence of myoclonus was 81%, 12% and 0% (groups N, R, and Q, respectively, P < 0.01). Side effects including bradycardia and hypotension did not occur in either Group R or Q. Chest wall rigidity occured in 45% of patients in Group Q.ConclusionsAdministration with a 2 ng/ml effect site concentration of remifentanil could reduce the incidence of myoclonus caused by etomidate bolus injection without chest wall rigidity.

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Glottic Closure Following Large Doses of Fentanyl

Cited by 46 publications

References 0 publications

μ-Opioid receptor agonist effects on medullary respiratory neurons in the cat: evidence for involvement in certain types of ventilatory disturbances

μ-Opioid receptor agonist effects on medullary respiratory neurons in the cat: evidence for involvement in certain types of ventilatory disturbances

Equipment and strategies for emergency tracheal access in the adult patient

The proper effect site concentration of remifentanil for prevention of myoclonus after etomidate injection

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