Fentanyl – MD Nexus

Indications

Increased Risk of Hepatic Encephalopathy (see Hepatic Encephalopathy, [[Hepatic Encephalopathy]])

Epidemiology: usually associated with high fentanyl doses during cardiothoracic surgery (however, may be seen at lower doses and with other opiates)
Physiology: may involve opioid receptors in the brainstem and basal ganglia
Clinical: may involve chest and abdominal wall
- Decreased Compliance/Increased Peak Inspiratory Pressures (PIP) on Mechanical Ventilation (see Ventilator Troubleshooting, [[Ventilator Troubleshooting]])
Treatment
- Naloxone (Narcan) (see Naloxone, [[Naloxone]]): may be used in cases where reversal of the effect of the opiate would not be detrimental
- Pharmacologic Paralysis: may be required in cases where reversal of the effect of the opiate would be deterimental

Respiratory Depression
- Acute Hypoventilation (see Acute Hypoventilation, [[Acute Hypoventilation]])
- Chronic Hypoventilation (see Chronic Hypoventilation, [[Chronic Hypoventilation]])

Postoperative rigidity following fentanyl anesthesia. Anesthesiology 1983;58: 275-7
Seizure-like movements during a fentanyl infusion with absence of seizure activity in a simultaneous EEG recording. Anesthesiology 1985;62:8124
Post-operative rigidity after fentanyl administration. Eur J Anaesthesiol 1986;3:4134
Generalized grand ma1 seizure after recovery from uncomplicated fentanyl-etomidate anesthesia. Anesth Analg 1986;65:979-81
Delayed muscular rigidity and respiratory depression following fentanyl anesthesia. Arch Surg 1988;123:66-7
Postoperative myoclonus and rigidity after anesthesia with opioids. Anesth Analg 1994; 78:783-786 [MEDLINE]