Fentanyl-induced Rigidity and Unconsciousness in Human Volunteers Incidence, Duration, and Plasma Concentrations

Streisand, James B.; Bailey, Peter L.; LeMaire, Leon; Ashburn, Michael A.; Tarver, Stephen D.; Varvel, John R.; Stanley, Theodore H.

doi:10.1097/00000542-199304000-00003

Cited by 93 publications

(71 citation statements)

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“…It has been reported that fentanyl-induced rigidity was accompanied by unconsciousness [1]. Therefore, remifentanilinduced rigidity may also be related to decrease in the level of consciousness.…”

Section: Introductionmentioning

confidence: 95%

Remifentanil Has Sufficient Hypnotic and Amnesic Effect for Induction of Anesthesia by Itself

Yokoyama

Shimizu²,

Yamasaki³

et al. 2014

OJAnes

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With a small-dose remifentanil, some patients showed no reaction and did not remember it postoperatively. We, therefore, hypothesized that remifentanil may decrease the level of consciousness and/or exhibit amnesic effect when stimulations are avoided. Thirty-patients were divided into two groups: non-stimulation group and stimulation group. Anesthesia was induced with 1 micro-g·kg −1 ·min −1 of remifentanil using no additional hypnotic agent. In the non-stimulation group, patients were left free from any stimulation except non-invasive blood pressure monitoring. In the stimulation group, patients were asked to follow verbal commands. The level of consciousness was evaluated with electroencephalogram and BIS-value derived from it. In the non-stimulation group, all patients reached the decreased level of consciousness in 5 minutes. In the stimulation group, however, 14 patients were judged to be still conscious. 10 patients could open their mouth at the 5th minute, but 9 of these 10 patients did not remember it postoperatively. In conclusion, remifentanil, with no additional anesthetics, exhibited hypnotic and amnesic effects when stimulations were kept minimal.

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Section: Introductionmentioning

confidence: 95%

Remifentanil Has Sufficient Hypnotic and Amnesic Effect for Induction of Anesthesia by Itself

Yokoyama

Shimizu²,

Yamasaki³

et al. 2014

OJAnes

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“…Some of these postinspiratory/expiratory neurons continue to discharge tonically, that is, continuously, at moderate to high opioid doses that cause apnea [see figure 9 in Lalley 2003 (359). Lalley proposes that such opioid effects on laryngeal adductor neurons may be correlated with the often observed difficulty in ventilating patients that receive moderate to large doses of fast acting μ-opioid agonists as part of a high-dose opioid cardiac anesthesia anesthetic induction sequence (2,43,346,659), since any tonically maintained, that is, constant vocal cord adduction should increase laryngeal airway resistance. Indeed, complete sustained tonic vocal cord closure results in the equivalent effect observed during laryngospasm (i.e., complete and sustained vocal cord adduction) with complete inability to manually ventilate these apneic patients by mask, but not through a tracheostomy.…”

Section: Effects Of Intravenous Fentanyl On Respiratory Neurons In Dementioning

confidence: 99%

Effects of Anesthetics, Sedatives, and Opioids on Ventilatory Control

Stuth

Stucke

Zuperku

2012

Comprehensive Physiology

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This article provides a comprehensive, up to date summary of the effects of volatile, gaseous, and intravenous anesthetics and opioid agonists on ventilatory control. Emphasis is placed on data from human studies. Further mechanistic insights are provided by in vivo and in vitro data from other mammalian species. The focus is on the effects of clinically relevant agonist concentrations and studies using pharmacological, that is, supraclinical agonist concentrations are de-emphasized or excluded.

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“…The rigid chest syndrome associated with fentanyl infusion is not well described with the transdermal fentanyl device. This may be related to the slower rate of rise of the serum levels with transdermal fentanyl devices than with IV infusion [83]. Mydriasis, vomiting and diarrhea, and piloerection may be used to identify opioid withdrawal.…”

Section: Clinical Effectsmentioning

confidence: 99%