Respiratory failure due to the combined effects of transdermal fentanyl and epidural bupivacaine/diamorphine following radical nephrectomy.
The transdermal therapeutic system (TTS) fentanyl has been designed for rate-controlled drug delivery. When the system is applied, a fentanyl depot concentrates in the upper skin layers. Plasma concentrations are not measurable until 2 hours after application, and it takes an 8-16 hr latency period until full clinical fentany effects are observed. Following removal, serum fentanyl concentrations decline gradually and fall to about 50% in approximately 16 hours. We report the case of a 77-year-old man with a history of severe arthritis, who was receiving transdermal fentanyl and developed respiratory failure after starting epidural diamorphine/bupivacaine for postoperative pain relief following radical nephrectomy.
Alsahaf
M H
MH
Anaesthetic Department, St. Helier Hospital NHS Trust, Carshalton, Surrey, United Kingdom.
Stockwell
M
M
D000279:Administration, Cutaneous; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D005283:Fentanyl / Q000009:adverse effects*; D003932:Heroin / Q000009:adverse effects*; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D009392:Nephrectomy; D011182:Postoperative Care / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000139:chemically induced*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D003932:Heroin; D005283:Fentanyl; D002045:Bupivacaine