Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fentanyl, though generally regarded as a short-acting narcotic analgesic, can give unexpected respiratory depression several hours after the last dose. This potentially very dangerous effect is explained in pharmacokinetic studies by a mobilisation of fentanyl from tissue stores. In this report we describe a patient who, following a Harrington correction for scoliosis done with neurolept analgesia, developed a severe respiratory depression 5 h after the last dose of fentanyl.
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PMID:Recurrence of respiratory depression following neurolept analgesia. 711 33

Cardiovascular, respiratory and analgesic effects of fentanyl and naloxone were studied in normotensive acutely decerebrated dogs. Naloxone (1 mg/kg, i.v.) increased skin twitch reflex latency, mean blood pressure, pulse pressure, respiratory rate and minute volume. Fentanyl (50 micrograms/kg, i.v.) decreased heart rate and blood pressure while the animals were artificially ventilated. The skin twitch reflex latency was not significantly altered. Nine minutes later, naloxone (1 mg/kg, i.v.) was administered and the fentanyl-induced cardiovascular depression was reversed above the control level. The skin twitch reflex latency remained unchanged. These findings give further evidence that the endogenous opioid system plays an important role in the brainstem control of circulation and respiration. The mechanism of the anomalous analgesic response of the acutely decerebrated dog requires further investigation.
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PMID:Effects of naloxone and fentanyl in acutely decerebrated dogs. 712 Dec 1

An anaesthetic technique using high-dose fentanyl for coronary artery surgery is described. Fentanyl 60 or 70 micrograms kg-1 was used as the sole anaesthetic agent, and patients were ventilated with air/O2 (fentanyl 70 micrograms kg-1) or N2O/O2 (fentanyl 60 micrograms kg-1). Cardiovascular data from 30 patients are presented. Fentanyl caused no significant cardiovascular depression. The only statistically significant changes in cardiovascular parameters were seen in the patients who received fentanyl 60 micrograms kg-1. Five minutes after skin incision there was an increase in peripheral resistance. Diastolic pressure was increased following sternotomy. Problems associated with this technique of anaesthesia are a 50% incidence of hypertension following sternotomy (requiring treatment with sodium nitroprusside) and prolonged respiratory depression. The lack of cardiovascular depression produced by fentanyl and the ability of fentanyl to reduce hormonal and metabolic responses to surgery make it a satisfactory technique for cardiac anaesthesia.
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PMID:Cardiovascular effects of high-dose fentanyl anaesthesia. 712 5

Following orthopedic surgery of the lower limb, ten patients were given fentanyl 5 micrograms . kg-1 in a single epidural injection. Almost complete analgesia (P less than 0.001) was rapidly obtained. The total period of analgesia was rather short (182.3 +/- 32.1 min). The maximal analgesia period was 87 +/- 8.34 minutes. Despite this high dose of fentanyl (245 to 450 micrograms), in five patients the passive mobilization of the knee following surgery was extremely painful and, for that matter, impossible in three of them. Such high doses of fentanyl entail the risk of respiratory depression as respiratory rate is decreased (P less than 0.01) and the Pco2 is increased (P less than 0.01). Fentanyl should not be used at such high dosage and should probably not be preferred to morphine, considering that the duration of analgesia is short, that the analgesic score is identical to that obtained with lower doses or with longer lasting narcotics, that it does not prevent passive mobilization pains and that it entails a definite risk of respiratory depression.
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PMID:[Peridural analgesia with high doses of fentanyl: failure of the method for early postoperative kinesitherapy in knee surgery]. 713 99

Effects of fentanyl (cumulative doses: 25, 75 and 125 micrograms.kg-1, i.v.) on respiratory, systemic and regional haemodynamic and biochemical variables were studied in the conscious rabbit. The initial dose of fentanyl (25 micrograms.kg-1) produced a rise in blood pressure and a decrease in heart rate but, on subsequent doses, smaller effects were observed. The drug produced changes in arterial blood gases which were due to a severe decrease in respiratory frequency and an increase in muscular rigidity of chest and neck muscles. The blood flow to skin, stomach, mesentery plus pancreas, bones and fat was decreased by fentanyl. These changes resemble those obtained during alpha-adrenergic stimulation and, thus, may be related to a release of catecholamines during respiratory depression. On the contrary, however, hepatic arterial blood flow was increased and this effect may be responsible for the rapid metabolism and a short duration of action of fentanyl. Fentanyl also caused an increase in the concentration of glucose, lactate and inorganic phosphates in the arterial blood. These changes are probably due to hypoxia. Administration of naloxone not only reversed the residual effects of previous fentanyl administration but also antagonized the respiratory, haemodynamic and biochemical responses to the morphinomimetic drug.
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PMID:Effects of fentanyl, and the antagonism by naloxone, on regional blood flow and biochemical variables in conscious rabbits. 716 16

Fentanyl is considered to be a short-acting narcotic analgesic but prolonged and recurrent ventilatory depression has been reported. We examined fentanyl kinetics and excretion in 7 healthy male subjects who were given a 3.2- or 6.4-micrograms/kg dose of 3H-fentanyl intravenously. Arterial blood and urine samples were analyzed for unchanged fentanyl and total radioactivity. Fentanyl concentrations fell rapidly and 98.6% of the dose was eliminated from plasma in 60 min but the terminal elimination phase of fentanyl from the body was slow (t1/2 beta = 219 min) due to the slow return of the unchanged drug from a peripheral compartment to the central compartment where elimination occurred primarily by biotransformation. Eighty-five percent of the dose was recovered in urine and feces in 72 hr; less than 8% was recovered as unchanged fentanyl. There were fluctuations in plasma fentanyl levels during the elimination phase in all cases. The long t1/2 beta and fluctuations in plasma levels may contribute to prolonged and recurrent ventilatory effects of fentanyl.
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PMID:Intravenous fentanyl kinetics. 738 47

This study made a longterm (72 hours) evaluation of the efficacy and possible side-effects of transdermal delivery of fentanyl (TTS-system) for post-operative pain relief. The study was double-blind, placebo-controlled with either a TTS-system delivering fentanyl 100 micrograms.h-1 and rescue analgesic on demand or a placebo system and analgesic on demand. Analgesic consumption, pain, general satisfaction, respiratory rate, and levels of SpO2 and tcCO2 (pulse oximetry and transcutaneous CO2 measuring) were evaluated. Recruitment was stopped after enrolment of 24 patients, on safety grounds. The Fentanyl group was more satisfied with postoperative pain relief (P = 0.008); they had a lower analgesic demand (P < 0.05) but also a lower respiratory rate (P < 0.05) and a higher level of tcCO2 23 hours after application (P < 0.05). There were three cases (25%) of increased PaCO2 (> 6.5 kPa) in the Placebo group but without low PaO2 levels, sedation or bradypnoea. Conversely, there were three cases (33%) in the Fentanyl group with bradypnoea (< 10 breaths/minute), two without influence on PaO2 or PaCO2, but one (no. 24) with bradypnoea, heavy sedation, a marked decrease in PaO2 (5.8 kPa) and increased PaCO2 (7.5 kPa). These findings terminated the study. The 100 micrograms transdermal fentanyl system is agreeable to the patients, but apparently too potent for routine postoperative pain relief due to a risk of respiratory depression. Respiratory frequency can not be relied upon as sole indicator of insufficient respiration.
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PMID:Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl. 748 44

The use of intravenous analgesia and anxiolytics in interventional radiology improves the patient's tolerance of potentially painful and prolonged procedures and allows the radiologist better control of the course of the procedure being undertaken. Monitoring of the patient's oxygen saturation, pulse rate, respiration, blood pressure and cardiac rhythm during a procedure is essential. Fentanyl and midazolam is a combination that is effective and convenient to use because both agents are relatively short acting, have little cardiovascular depression and are easily reversible (with naloxone and flumazenil). They are a better alternative to pethidine and diazepam because they can be more tightly titrated and controlled and are safer and more suitable for use in outpatients. Monitoring for respiratory depression is important and special care must be taken in the elderly and patients with hepatic, renal or chronic airways disease. General anaesthesia may be unavoidable in patients who are unstable, unco-operative or who have raised intracranial pressure.
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PMID:Analgesia and sedation in interventional radiological procedures. 760 16

We carried out a controlled, randomized, double-blind study to examine the effects of intravenous fentanyl (1 or 2 micrograms kg-1) on hemodynamic changes during tracheal extubation and emergence from anesthesia in 60 ASA physical status I or II patients undergoing elective gynecological surgery. Anesthesia was maintained with 0.5%-1.5% isoflurane and 60% nitrous oxide (N2O) in oxygen. Muscle relaxation was achieved with vecuronium. The patients were randomly assigned to three group (each, n = 20), and fentanyl (1 or 2 micrograms kg-1), or saline (as a control) was given at the time of peritoneal closure. Changes in heart rate (HR) and blood pressure (BP) were measured during and after tracheal extubation. Adverse effects, including postoperative sedation and respiratory depression, were also assessed. The HR, systolic BP, and diastolic BP increased significantly during tracheal extubation in the control group (P < 0.05). Fentanyl 2 micrograms kg-1 attenuated the increases in these variables more effectively than fentanyl 1 microgram kg-1. The time interval from the study drug to extubation was similar in each group. Postoperative somnolence and respiratory depression were not observed in any patients in any of the three groups. We concluded that a bolus dose of intravenous fentanyl 2 micrograms kg-1 given at the time of peritoneal closure was of value in attenuating the cardiovascular changes associated with tracheal extubation and emergence from anesthesia, and that this treatment did not prolong the recovery. However, further studies are required to assess this technique in patients with cardiovascular or cerebrovascular diseases.
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PMID:Fentanyl attenuates cardiovascular responses to tracheal extubation. 772 88

No study has compared anaesthetic protocols appropriate for the sedation for fiberoptic tracheal intubation. Extrapolation of results of randomised studies comparing sedation techniques for diagnostic bronchoscopy under local anaesthesia enables the following conclusions: 1. Possible hypnotic agents for this procedure are benzodiazepines, barbiturates and propofol. Fentanyl improves the conditions for bronchoscopy. 2. Sedation using propofol is a well established technique. The induction dose, given as a bolus injection is 1 mg.kg-1, followed by continuous maintenance infusion of 1 mg.kg.h-1. 3. Irrespective of the sedation protocol used, there is always respiratory depression which justifies the need for preoxygenation, continuous oxygenation and Spo2 monitoring. Reversal of benzodiazepine and opioid effects may temporarily protect against respiratory depression.
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PMID:[Diprivan: sedation for difficult intubation]. 787 57


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