[High doses of fentanyl as the sole anaesthetic agent and naloxone as its antagonist (author's transl)].
In 70 patients (maxillo-facial-, neurosurgical-, abdominal- and gynaecological operations) the technique of "analgetic anaesthesia" using high doses of fentanyl (0.025 mg/kg body weight) and naloxone as its antagonist (0.02 mg/kg body weight) has been employed. All patients were artificially ventilated with N2O/O2 in a 3:1 ratio. Muscle relaxation was achieved with pancuronium-bromide (0.08 mg/kg). The patients had no apparent heart or lung disease. The youngest patient was 4 years of age, the oldest 82 years of age (average age 48.9). The necessity for a reinjection of fentanyl (half the initial dose) was determined by continously monitoring heart rate. This variable appeared to be the most subtle index indicating a reduction in analgesia. Sufficient analgesia was maintained once the heart rate stayed 20% below preanaesthetic levels. At the end of the operation naloxone reversed the respiratory depression. There was no evidence indicating postoperative pain, which may have required administration of additional analgesics. If deep analgesia was maintained up to the last surgical procedures no emesis appeared in the post operative period. The incidence of emesis was higher 10% compared to the classical neuroleptanalgesia with droperidol this was often noted in cases where blood accumulated in the stomach (maxillo-facial operations) (70%). In 3% of all cases psychomotor agitation with delirium appeared right after the injection of naloxone. This lasted for about 15 minutes. We suspect that due to the sudden and powerful effect of naxolone, in replacing fentanyl from its receptor site, acute withdrawal symptoms may be precipitated.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia; D001341:Autonomic Nervous System / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D005831:Genital Diseases, Female / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D009325:Nausea / Q000139:chemically induced; D009493:Neurosurgery; D013610:Tachycardia / Q000139:chemically induced; D014839:Vomiting / Q000139:chemically induced
D009270:Naloxone; D005283:Fentanyl
Die Anwendung hoher Dosen von Fentanyl und Naloxone in der Anaesthesie