Ventilatory Depression Related to Plasma Fentanyl Concentrations During and After Anesthesia in Humans

CARTWRIGHT, P.; Prys‐Roberts, C.; GILL, K.; Dye, A. M.; Stafford, Matthew; Gray, Andrew T.

doi:10.1097/00132586-198406000-00024

Cited by 14 publications

(17 citation statements)

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“…The background infusion amount of D8-4-2 was 4 times greater than the fixed-infusion group, but the gross inspection of the simulation graphs of the C eff of fentanyl (Fig. 3) showed that C eff hardly exceeded the 2.0 ng/ml of C eff that had been reported to increase the incidence of ventilatory depression [15], and in D8-4-2 (Fig. 3C), the C eff of fentanyl of two subjects after PCA boluses, approached to 2.0 ng/ml, but no case of respiration rate less than 6 /min was recorded during the period of PACU or ward.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the analgesic concentration in the body might be insufficient to the severity of the early postoperative pain during the fixed-rate infusion of the recommended regimens (< 1.1 µg/kg/hr) [1,5,7,13,14]. But fixed-set to higher rates (1.25-2.0 µg/kg/hr) [6,13] might increase the risk of side effects, such as ventilatory depression, while 50% depressing the slope of the ventilation-CO 2 response curve at the C p of fentanyl between 2.0-3.1 ng/ml [15]. …”

Section: Introductionmentioning

confidence: 99%

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The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia

Kim

Park

Chang

et al. 2013

Korean J Anesthesiol

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BackgroundIntravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia.MethodsNinety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 µg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated.ResultsVAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups.ConclusionsThe time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia

Kim

Park

Chang

et al. 2013

Korean J Anesthesiol

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“…Frequent dosing requirements may not be convenient in the clinical veterinary setting, and animals requiring long‐term analgesia may not be provided with adequate pain control over an extended period of time. In addition to being inconvenient, periodic dosing results in peak and trough plasma concentrations that can lead to toxicosis and undesirable side effects such as excessive sedation and respiratory depression (Cardocki & Yelnosky 1964; Hug & Murphy 1979; Cartwright et al. 1983; Andrews et al.…”

Section: Introductionmentioning

confidence: 99%

Plasma fentanyl concentrations in awake cats and cats undergoing anesthesia and ovariohysterectomy using transdermal administration

Egger

Glerum

Allen

et al. 2003

Veterinary Anaesthesia and Analgesia

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“…Variability in cerebrospinal fluid concentrations of endogenous opioids may also contribute to these observed differences (Cohen et al 1982; Tamsen et al 1982). The requirement for higher than estimated blood concentrations typically sufficient to elicit clinically significant analgesia (~1 ng/mL) may result in ventilatory depression (at >2 ng/mL) (Cartwright et al 1983). This need for additional supportive analgesia without severe respiratory depression led to the development of the oral transmucosal fentanyl delivery system.…”

Section: Oral Transmucosal Fentanyl Citrate and Cancer Painmentioning

confidence: 99%

Oral transmucosal fentanyl citrate in cancer pain management: a practical application of nanotechnology

Mystakidou¹,

Tsilika²,

Tsiatas³

et al. 2007

International Journal of Nanomedicine

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Abstract:Pain is experienced by most cancer patients and represents an important issue in the clinical setting. Breakthrough pain is a transitory fl are of pain that occurs in most cancer patients on a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate (OTFC; Actiq ® , Cephalon, UK), a new opioid formulation with a unique delivery system, utilizing the advantages that nanotechnology offers, refl ects the characteristics of breakthrough pain (rapid onset of action and short duration), which makes it an effective treatment to cancer patients who are already receiving opioids and continue to experience such fl ares of pain. Oral transmucosal fentanyl citrate is specifi cally developed and approved for the management of breakthrough pain in cancer patients and it has the potential to be a useful tool for clinicians.

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Ventilatory Depression Related to Plasma Fentanyl Concentrations During and After Anesthesia in Humans

Cited by 14 publications

References 0 publications

The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia

The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia

Plasma fentanyl concentrations in awake cats and cats undergoing anesthesia and ovariohysterectomy using transdermal administration

Oral transmucosal fentanyl citrate in cancer pain management: a practical application of nanotechnology

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