Preoperative fentanyl infusion with pharmacokinetic simulation for anesthetic and perioperative management of an opioid-tolerant patient.
For opioid-tolerant patients, conventional patient-controlled analgesia dosing may be ineffective. We present a cardiac surgery patient with a history of significant opioid tolerance and prior episodes of severe postoperative pain. Using the patient's response to a large-dose fentanyl infusion in conjunction with a pharmacokinetic simulation, effective intraoperative and postoperative fentanyl plasma concentrations were achieved.


CONCLUSIONS
A preinduction fentanyl infusion used in conjunction with pharmacokinetic simulation can be a useful tool for assessing individual limits of opioid tolerance, as well as determining an appropriate dose for acute pain management in opioid-tolerant patients.
Davis
Jennifer J
JJ
From the Department of Anesthesiology, University of Utah Medical Center, Salt Lake City, Utah.
Johnson
Kenward B
KB
Egan
Talmage D
TD
Vezina
Daniel P
DP
Snell
Timothy E
TE
Swenson
Jeffrey D
JD
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D000758:Anesthesia; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D001569:Benzodiazepines / Q000009:adverse effects; D003198:Computer Simulation; D004342:Drug Hypersensitivity / Q000150:complications; D004361:Drug Tolerance; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D011300:Preoperative Care; D015742:Propofol; D014261:Tricuspid Valve / Q000601:surgery
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D001569:Benzodiazepines; D005283:Fentanyl; D015742:Propofol