Hemodynamic Changes during Fentanyl—Oxygen Anesthesia for Aortocoronary Bypass Operation

Waller, John L.; Hug, Carl C.; Nagle, David; Craver, Joseph M.

doi:10.1097/00000542-198109000-00005

Cited by 113 publications

(12 citation statements)

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“…Wynands 9 has had a similar experience. In contrast, Waller, et al 6 reported a much higher incidence of hypertension during operation especially after severe surgical stress (maximal sternal spread) during CABG operations with high does fentanyl anaesthesia. Although it is unreported, all of Stanley, et al's patients in one study and most in the other were taking propranolol and received their last doses of this compound on the morning of operation.…”

Section: Discussionmentioning

confidence: 93%

The influence of chronic preoperative propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease

Stanley

Lange

Boscoe

et al. 1982

Can. Anaesth. Soc. J.

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We measured the dose of sufentanil required for unconsciousness as well as the entire operation in 44 patients (22 taking propranolol and 22 not taking propranolol) undergoing coronary artery bypass grafting (CABG) operations. The incidence of hypertension during operation, requirements for supplements to treat hypertension and recovery times were also determined. The data indicate that patients undergoing CABG operations taking propranolol require significantly less sufentanil for unconsciousness and the entire operation than patients not taking this drug. In spite of requiring less sufentanil, patients taking propranolol had less hypertension during operation and thus required less supplements. However recovery times in both groups were the same.The results of this study may partially explain the varying incidence of hypertension reported during high dose fentanyl and other narcotic-oxygen anaesthetic techniques.

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Section: Discussionmentioning

confidence: 93%

The influence of chronic preoperative propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease

Stanley

Lange

Boscoe

et al. 1982

Can. Anaesth. Soc. J.

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“…Given the possible role of muscle stiffness in the depression of tidal volume, it is interesting to note that δ opioid agonists have been shown to inhibit alfentanil-induced muscle stiffness (Vankova et al, 1996) In man, i.v. administration of high doses of fentanyl and alfentanil produces skeletal muscle rigidity resulting in stiffness of the chest wall (Benthuysen et al, 1986;Streisand et al, 1993;Waller, Hug, Nagle, & Craver, 1981). Brain microinjection studies in rats have implicated several brain regions-locus coeruleus, basal ganglia, nucleus raphe pontis, and periaqueductal grey-as sites of action of fentanyls to induce muscle rigidity (Blasco et al, 1986;Lui, Lee, & Chan, 1989;Lui, Lee, & Chan, 1990;Slater & Starkie, 1987;Weinger et al, 1991;Widdowson, Griffiths, & Slater, 1986) and have shown that it is mediated by activation of μ, and not δ or κ opioid receptors (Vankova et al, 1996).…”

Section: Discussionmentioning

confidence: 99%

Fentanyl depression of respiration: Comparison with heroin and morphine

Hill

Santhakumar

Dewey

et al. 2019

British J Pharmacology

139

119

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Background and Purpose: Fentanyl overdose deaths have reached "epidemic" levels in North America. Death in opioid overdose invariably results from respiratory depression. In the present work, we have characterized how fentanyl depresses respiration, and by comparing fentanyl with heroin and morphine, the active breakdown product of heroin, we have sought to determine the factors, in addition to high potency, that contribute to the lethality of fentanyl.Experimental Approach: Respiration (rate and tidal volume) was measured in awake, freely moving mice by whole body plethysmography.Key Results: Intravenously administered fentanyl produced more rapid depression of respiration than equipotent doses of heroin or morphine. Fentanyl depressed both respiratory rate and tidal volume. Fentanyl did not depress respiration in μ-opioid receptor knockout mice. Naloxone, the opioid antagonist widely used to treat opioid overdose, reversed the depression of respiration by morphine more readily than that by fentanyl, whereas diprenorphine, a more lipophilic antagonist, was equipotent in reversing fentanyl and morphine depression of respiration. Prolonged treatment with morphine induced tolerance to respiratory depression, but the degree of cross tolerance to fentanyl was less than the tolerance to morphine itself. Conclusion and Implications:We propose that several factors (potency, rate of onset, lowered sensitivity to naloxone, and lowered cross tolerance to heroin) combine to make fentanyl more likely to cause opioid overdose deaths than other commonly abused opioids. Lipophilic antagonists such as diprenorphine may be better antidotes than naloxone to treat fentanyl overdose.

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“…The incidence of rigidity during the administration of large doses of opiates is controversial (9, [11][12][13]. Whereas some authors have reported a very low incidence of rigidity (8) or even no rigidity (14) during fentanyl administration, others have noted a high incidence of chest wall rigidity, ranging from 70% (15,16) to nearly 100% (7,9,17). The administration of 0.02 mg/kg pancuronium bromide ( 1,8) and pretreatment with droperidol (15) or a benzodiazepine derivate (4) has been suggested to prevent or at least reduce the occurrence of rigidity.…”

Section: Discussionmentioning

confidence: 99%

Chest wall rigidity during fentanyl– and midazolam–fentanyl induction: ventilatory and haemodynamic effects

Neidhart

Burgener

Schwieger

et al. 1989

Acta Anaesthesiol Scand

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In a double-blind randomised study, we examined if pretreatment with small doses of midazolam, given before anaesthesia induction with fentanyl, influences the occurrence of fentanyl-induced thoracic rigidity (FITR). At the same time, the effect of rigidity on the cardiovascular and respiratory system was assessed. Sixteen patients undergoing coronary artery bypass surgery were divided into two groups. The midazolam group (M) received 0.075 mg/kg midazolam i.v. and the placebo group (P) NaCl 0.9% 3 min before the start of fentanyl induction. During the induction period, FITR was assessed clinically on a 3-point scale. Haemodynamic and respiratory variables were collected before anaesthesia induction, at the end of the fentanyl infusion and 3 min after intubation. The incidence of FITR was high in both groups: 63% in Group M and 75% in Group P (n.s.); however, its severity was less in Group M. The appearance of rigidity affected the cardiovascular and the respiratory system: central venous and pulmonary capillary wedge pressures showed a sharp increase in patients with FITR accompanied by CO2 retention, due to an inability to ventilate these patients adequately. We conclude that small doses of midazolam do not prevent, but may attenuate, FITR and that the appearance of rigidity causes alterations of haemodynamic and respiratory variables during induction.

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Hemodynamic Changes during Fentanyl—Oxygen Anesthesia for Aortocoronary Bypass Operation

Cited by 113 publications

References 0 publications

The influence of chronic preoperative propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease

The influence of chronic preoperative propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease

Fentanyl depression of respiration: Comparison with heroin and morphine

Chest wall rigidity during fentanyl– and midazolam–fentanyl induction: ventilatory and haemodynamic effects

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