Influence of Bolus Doses of Phenoperidine on Intracranial Pressure and Systemic Arterial Pressure in Traumatic Coma

Bingham, Robert; Hinds, C. J.

doi:10.1093/bja/59.5.592

Cited by 12 publications

(3 citation statements)

References 7 publications

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“…One study (25) was a prospective cohort study. Nine studies (12,14,(17)(18)(19)21,28,29,32) were pre-post test studies. The total pooled sample size of all included studies was 792, with study sample sizes ranging from 6 to 161.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All included studies were conducted in intensive care units, such that all patients were receiving mechanical ventilation. Sedation was administered prior to intervention in the majority of studies: midazolam in 12 studies (15,16,19,20,23,(26)(27)(28)(29)(30)(31)(32), propofol in 6 studies (12,13,17,18,21,23), etomidate in 1 study (14), and diazepam in 1 study (33). Four studies (22)(23)(24)(25) reported that no sedatives were administered before at least one of the interventions.…”

Section: Study Settingmentioning

confidence: 99%

“…Alfentanil was evaluated in two studies (13,22), which reported that alfentanil, delivered intravenously by bolus or infusion, was associated with increased ICP and decreased CPP and MAP. Phenoperidine was evaluated in a single study (14), which demonstrated significant decreases in CPP and MAP, but no significant changes in ICP.…”

Section: )mentioning

confidence: 99%

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Opioids and cerebral physiology in the acute management of traumatic brain injury: a systematic review

et al. 2019

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Background: Following traumatic brain injury (TBI), optimization of cerebral physiology is recommended to promote more favourable patient outcomes. Accompanying pain and agitation are commonly treated with sedative and analgesic agents, such as opioids. However, the impact of opioids on certain aspects of cerebral physiology is not well established. Objective: To conduct a systematic review of the evidence on the effect of opioids on cerebral physiology in TBI during acute care. Methods: A comprehensive literature search was conducted in five electronic databases for articles published in English up to November 2017. Studies were included if: (1) the study sample was human subjects with TBI; (2) the sample size was ≥3; (3) subjects were given an opioid during acute care; and (4) any measure of cerebral physiology was evaluated. Cerebral physiology measures were intracranial pressure (ICP), cerebral perfusion pressure (CPP), and mean arterial pressure (MAP). Subject and study characteristics, treatment protocol, and results were extracted from included studies. Randomized controlled trials were evaluated for methodological quality using the Physiotherapy Evidence Database tool. Levels of evidence were assigned using a modified Sackett scale. Results: In total, 22 studies met inclusion criteria, from which six different opioids were identified: morphine, fentanyl, sufentanil, remifentanil, alfentanil, and phenoperidine. The evidence for individual opioids demonstrated equally either: (1) no effect on ICP, CPP, or MAP; or (2) an increase in ICP with associated decreases in CPP and MAP. In general, opioids administered by infusion resulted in the former outcome, whereas those given in bolus form resulted in the latter. There were no significant differences when comparing different opioids, with the exception of one study that found fentanyl was associated with lower ICP and CPP than morphine and sufentanil. There were no consistent results when comparing opioids to other non-opioid medications. Conclusion: Several studies have assessed the effect of opioids on cerebral physiology during the acute management of TBI, but there is considerable heterogeneity in terms of study methodology and findings. Opioids are beneficial in terms of analgesia and sedation, but bolus administration should be avoided to prevent additional or prolonged unfavourable alterations in cerebral physiology. Future studies should better elucidate the effects of different opioids as well as varying dosages in order to develop improved understanding as well as allow for tighter control of cerebral physiology.

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