Intraoperative high-dose remifentanil in a patient on naltrexone therapy.
Naltrexone hydrochloride is a synthetic opioid receptor antagonist recently used in efforts to provide rapid opioid detoxification. Other clinical uses include alleviating itch due to cholestasis or uraemia. We report a case where unrecognised naltrexone therapy for itch affected anaesthesia, resulting in high opioid requirements. We also discuss other analgesic options utilized.
Schwab
C A
CA
Department of Anaesthesia, Royal Perth Hospital, Perth, Western Australia.
Wright
D A
DA
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D001164:Arteriovenous Fistula / Q000601:surgery; D003646:Debridement; D005260:Female; D016523:Foot Ulcer / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000188:drug therapy* / Q000209:etiology; D009271:Naltrexone / Q000009:adverse effects* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D000077208:Remifentanil; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D010880:Piperidines; D009271:Naltrexone; D000077208:Remifentanil