Ventilatory effects of subarachnoid fentanyl in the elderly

Twenty‐eight elderly patients scheduled for urological surgery were randomly assigned to receive, in a double‐blind study, subarachnoidhyperbaric bupivacaine 15 mg with 50 μg (group A, n = 7), 25 μg (group B, n = 7), or 12.5 μg (group C, n = 7) of fentanyl or 1 ml of saline (group D, n = 7) in a total volume of 4 ml. The pattern of breathing and the ventilatory response to CO2 were studied before and 90, 150 and 480 min after the subarachnoid injection. In group A, mild pruritus and sedation occurred in five patients, while nausea, vomiting and periodic breathing occurred in two. In group B, mild pruritus and sedation were observed in four patients, while nausea and vomiting occurred in two. No significant differences in minute ventilation, respiratory drive and respiratory timing were observed between the groups. Patients receiving fentanyl 50 ug showed a percentual change from baseline values as function of time (slope V̇E/PE'co2 significantly below baseline at 90 and 150 min (p < 0.05). However, the baseline values in this group reverted after 480 min. No side effects were observed in groups C or D. It is concluded that subarachnoid fentanyl 50 μg can cause an early respiratory depression and its use as a postoperative analgesic should be avoided in the elderly.

[1]  D. Silage,et al.  Effects of aging on ventilatory and occlusion pressure responses to hypoxia and hypercapnia. , 2015, The American review of respiratory disease.

[2]  J. Plummer,et al.  Pharmacokinetics of fentanyl in lumbar and cervical CSF following lumbar epidural and intravenous administration , 1989, Pain.

[3]  B. Veering,et al.  Spinal anaesthesia with hyperbaric bupivacaine. Effects of age on neural blockade and pharmacokinetics. , 1988, British journal of anaesthesia.

[4]  C. O. Hunt,et al.  FKRIOPERATIVE ANALGESIA WITH SUBARACHNOID FENTANYL-BUPIVACAINE , 1987 .

[5]  T. Bohannon,et al.  EVALUATION OF SUBARACHNOID FENTANYL FOR POSTOPERATIVE ANALGESIA , 1987 .

[6]  C. Benedetti.  Intraspinal analgesia: an historical overview , 1987, Acta anaesthesiologica Scandinavica. Supplementum.

[7]  J. Leysen,et al.  Epidural and Intravenous Sufentanil in the Rat: Analgesia, Opiate Receptor Binding, and Drug Concentrations in Plasma and Brain , 1986, Anesthesiology.

[8]  L. Gustafsson,et al.  Distribution of Morphine and Meperidine after Intrathecal Administration in Rat and Mouse , 1985, Anesthesiology.

[9]  L. Strunin,et al.  Respiratory effects of epidural fentanyl , 1985, Anaesthesia.

[10]  D. Fisher,et al.  Pharmacokinetics of fentanyl in the elderly. , 1985, British journal of anaesthesia.

[11]  J. Levron,et al.  Clinical assessment and plasma pharmacokinetics associated with intramuscular or extradural alfentanil. , 1985, British journal of anaesthesia.

[12]  J. Levron,et al.  C02 SENSITIVITY AFTER EPIDURAL FENTANYL , 1985 .

[13]  J. Brichant,et al.  CONTINUOUS EPIDURAL FENTANYL: VENTILATORY EFFECTS AND PLASMA KINETICS , 1985 .

[14]  D R Stanski,et al.  The Effect of Increasing Age on Thiopental Disposition and Anesthetic Requirement , 1985, Anesthesiology.

[15]  J. Kinney,et al.  SPLANCHNIC OXYGEN CONSUMPTION AND SUBSTRATE RALANCE FOLLOWING ACCIDENTAL INJURY , 1984 .

[16]  H. McQuay,et al.  Plasma Morphine Concentrations and Analgesic Effects of Lumbar Extradural Morphine and Heroin , 1984, Anesthesia and analgesia.

[17]  P. Brownridge,et al.  Respiratory Depression following Accidental Subarachnoid Pethidine , 1983, Anaesthesia and intensive care.

[18]  M. Rosen,et al.  Epidural Morphine for the Relief of Postoperative Pain after Cesarean Delivery , 1983, Anesthesia and analgesia.

[19]  T. Gillespie,et al.  Age and Fentanyl Pharmacokinetics , 1982, Anesthesia and analgesia.

[20]  Robert Vestal.  Pharmacology and Aging , 1982, Journal of the American Geriatrics Society.

[21]  T. L. James,et al.  CNS depression from intrathecal morphine. , 1980, Anesthesiology.

[22]  J. Eisele,et al.  Fentanyl Concentrations in Brain and Serum during Respiratory Acid—Base Changes in the Dog , 1979, Anesthesiology.

[23]  I. Dyrenfurth,et al.  RELIEF OF STRESS WITH MEPERIDINE IN PREGNANT BABOONS AND SHEEP , 1979 .

[24]  L. Mather,et al.  SPINAL NARCOTICS AND RESPIRATORY DEPRESSION , 1979, The Lancet.

[25]  C. Hug,et al.  Fentanyl Disposition in Cerebrospinal Fluid and Plasma and Its Relationship to Ventilatory Depression in the Dog , 1979, Anesthesiology.

[26]  T. Yaksh,et al.  Analgesia mediated by a direct spinal action of narcotics. , 1976, Science.

[27]  Read Dj,et al.  A clinical method for assessing the ventilatory response to carbon dioxide. , 1967 .

[28]  S. C. Hughes.  Subarachnoid and Epidural Analgesics in Obstetrics , 1987 .

[29]  P. Trinh-Duc,et al.  Intérêt de l'association bupivacaïne-fentanyl isobare en rachianesthésie , 1987 .

[30]  P. Capiau,et al.  Cardiac arrest after spinal sufentanil: case report. , 1987, Acta anaesthesiologica Belgica.

[31]  L. Mather,et al.  Intrathecal and epidural administration of opioids. , 1984, Anesthesiology.

[32]  D. Read,et al.  A clinical method for assessing the ventilatory response to carbon dioxide. , 1967, Australasian annals of medicine.