Pulmonary oedema due to fentanyl?

Soto, José Luis Viruez; Sacristán, José Antonio; Alsar, M J

doi:10.1111/j.1365-2044.1992.tb03179.x

Cited by 10 publications

(5 citation statements)

References 6 publications

(4 reference statements)

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“…Although the clinical relevance of complement activation by propofol is not clear, 17 the possibility of the occurrence of complications such as pulmonary edema should be considered. 29,30 So far, however, no reports have shown the occurrence of pulmonary edema with use of LCT/MCT propofol.…”

Section: Bradykinin Generation and Complement Activationmentioning

confidence: 99%

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Ohmizo

Obara

Iwama

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : t has been suggested that long-medium chain triglyceride (LCT/MCT) emulsive propofol causes less injection pain than long chain triglyceride (LCT) emulsive propofol because of the decreased propofol concentration in the aqueous phase. Alternatively, LCT propofol generates bradykinin causing the injection pain and activates complement, but these effects when using LCT/MCT propofol have not been examined. To identify the mechanism for reduced pain with LCT/MCT propofol, injection pain, bradykinin generation and complement activation with use of both propofol products were compared.M Me et th ho od ds s: : Two hundred adult patients randomly allocated to two groups were given 1.5 mg·kg -1 iv of either LCT propofol or LCT/MCT propofol at a rate of 200 mg·min -1 in a double-blind manner and were asked to grade pain scores. In another study, bradykinin and activated complement 3 (C3a) concentrations were measured using blood obtained from 13 healthy volunteers mixed with saline, LCT propofol or LCT/MCT propofol.R Re es su ul lt ts s: : There was a significant difference in pain scores between groups, showing a lower incidence of injection pain in the LCT/MCT propofol group. The bradykinin concentrations in blood mixed with LCT and LCT/MCT propofol were significantly higher than in blood mixed with saline. The C3a concentrations showed similar results.C Co on nc cl lu us si io on ns s: : LCT/MCT propofol causes less pain on injection compared with LCT propofol. Bradykinin generation and complement activation are similar with both LCT and LCT/MCT propofol. Thus, the reason for less pain on injection with LCT/MCT propofol may be attributed to a decreased concentration of propofol in the aqueous phase. Objectif : On a pensé qu'une émulsion de propofol avec une chaîne mi-longue de triglycéride (CLT/CMT) cause moins de douleur à l'injection qu'une émulsion à chaîne longue (CLT) parce que la concentration de propofol diminue pendant la phase aqueuse. Aussi, le propofol avec CLT génère de la bradykinine, causant de la douleur à l'injection, et active le complément, mais ces effets n'ont pas été étudiés avec le propofol CLT/CMT. Pour définir le mécanisme qui réduit la douleur avec le propofol CLT/CMT, nous avons comparé la douleur à l'injection, la génération de bradykinine et l'activation du complément avec l'usage des deux produits de propofol. Méthode : Deux cents patients adultes ont été répartis au hasard en deux groupes et ont reçu 1,5 mg·kg -1 iv de propofol CLT ou CLT/CMT

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Section: Bradykinin Generation and Complement Activationmentioning

confidence: 99%

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Ohmizo

Obara

Iwama

2005

Can J Anesth/J Can Anesth

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“…Pulmonary edema has been described as an adverse effect of opioid intoxication without naloxone administration. 5,6 However, there is evidence to support either a direct or additive effect of naloxone in causing this outcome. An article by Mills et al 12 examined the additive cardiovascular effects of naloxone reversal in an animal model of opioid toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 It has also been described as a complication of heroin and fentanyl intoxication without the use of naloxone. [4][5][6] Reversal of opioid intoxication with naloxone has been implicated in intrinsically causing pulmonary edema through several theorized mechanisms. One hypothesized physiologic cause is negative pressure resulting from inspiration against a closed glottis.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Pulmonary Complications of Opioid Overdose Treated With Naloxone

Farkas

Lynch

Westover

et al. 2020

Annals of Emergency Medicine

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We aim to determine whether administration of higher doses of naloxone for the treatment of opioid overdose is associated with increased pulmonary complications.Methods: This was a retrospective, observational, cross-sectional study of 1,831 patients treated with naloxone by the City of Pittsburgh Bureau of Emergency Medical Services. Emergency medical services and hospital records were abstracted for data in regard to naloxone dosing, route of administration, and clinical outcomes, including the development of complications such as pulmonary edema, aspiration pneumonia, and aspiration pneumonitis. For the purposes of this investigation, we defined highdose naloxone as total administration exceeding 4.4 mg. Multivariable analysis was used to attempt to account for confounders such as route of administration and pretreatment morbidity.Results: Patients receiving out-of-hospital naloxone in doses exceeding 4.4 mg were 62% more likely to have a pulmonary complication after opioid overdose (42% versus 26% absolute risk; odds ratio 2.14; 95% confidence interval 1.44 to 3.18). This association remained statistically significant after multivariable analysis with logistic regression (odds ratio 1.85; 95% confidence interval 1.12 to 3.04). A secondary analysis showed an increased risk of 27% versus 13% (odds ratio 2.57; 95% confidence interval 1.45 to 4.54) when initial naloxone dosing exceeded 0.4 mg. Pulmonary edema occurred in 1.1% of patients. Conclusion:Higher doses of naloxone in the out-of-hospital treatment of opioid overdose are associated with a higher rate of pulmonary complications. Furthermore, prospective study is needed to determine the causality of this relationship.

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“…[1][2][3][4][5] Also, there is one report of pulmonary edema following ketamine administration in a patient who had a history of crack cocaine abuse. 6 In animals, pulmonary edema has been described after administration of xylazine-ketamine.…”

Section: Discussionmentioning

confidence: 99%

Fulminant pulmonary edema after intramuscular ketamine

Pandey

Mathur

Singh

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To report an unusual case of pulmonary edema following intramuscular ketamine administration. Clinical Features: An eight-year-old, healthy girl presented for dressing of first degree burns on dorsum of hand. Ten minutes after administration of 125 mg ketamine im, she developed laboured breathing, cyanosis, and bilateral crepitations and arterial blood gas analysis showed PaO 2 55 mmHg. There was no evidence of upper airway obstruction. On intubating the trachea, pink frothy fluid emerged from the tube. She was diagnosed as a case of neurogenic pulmonary edema. She was managed with positive pressure ventilation with positive end expiratory pressure, morphine and furosemide. With this treatment she showed a favourable recovery. Conclusion:Ketamine was given im to aid burns dressing in this case because it has distinct advantages above the other anesthetic agents including that of being a good analgesic which is absorbed by im route. Its use led to the development of pulmonary edema.Objectif : Signaler un cas inhabituel d'oedème pulmonaire survenu après l'administration intramusculaire de ké-tamine.Éléments cliniques : Une fillette de 8 ans, en bonne santé, s'est présentée pour un pansement sur des brûlures de premier degré au dos de la main. Dix minutes après l'administration de 125 mg de kétamine im, elle a présen-té une gêne respiratoire, de la cyanose et des crépitations bilatérales. La gazométrie artérielle a montré une PaO 2 de 55 mmHg. Il n'y avait pas d'évidence d'obstruction des voies aériennes supérieures. À l'intubation de la trachée, un liquide rosé spumeux sortait du tube. On a posé le diagnostic d'oedème pulmonaire neurogène. La ventilation à pression positive avec pression positive en fin d'expiration, de la morphine et du furosémide ont constitué le traitement. L'enfant a connu une bonne récupération.Conclusion : La kétamine im a été utilisée pour faciliter le pansement de brûlures à cause de ses avantages particuliers par rapport aux autres anesthésiques. En effet, elle fournit une bonne analgésie absorbée par voie im. Son emploi a provoqué l'apparition d'un oedème pulmonaire.

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Pulmonary oedema due to fentanyl?

Abstract: References[I] GERRING JP, SHIELDS HM. The identification of patients with a high risk for cardiac arrhythmias during modified ECT.

Cited by 10 publications

References 6 publications

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Pulmonary Complications of Opioid Overdose Treated With Naloxone

Fulminant pulmonary edema after intramuscular ketamine

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