Naloxone-induced pulmonary edema: a potential cause of postoperative morbidity in laparoscopic donor nephrectomy.
A 28-year-old patient operated for laparoscopic donor nephrectomy (LDN) developed overdose effect of fentanyl leading to poor postoperative recovery. Naloxone (200 microg) treatment was used to reverse fentanyl effects, but it was associated with hypertension. The patient developed pulmonary edema after 2 hours and required overnight mechanical ventilation with positive end-expiratory pressure. Volume overload prescribed in the management of LDN to overcome the immediate poor renal graft functioning probably predisposed this healthy young patient to develop cardiac failure during sympathetic surge associated with naloxone administration. The authors feel that the reversal of overdose effect of opioid by naloxone after intravascular blood volume expansion puts the patient at risk to develop pulmonary edema.
Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institue of Medical Sciences, Lucknow, India.
Soumya Shankar
SS
Nath
Mukesh
M
Tripathi
Chadrakant
C
Pandey
Bhaskar
B
Rao
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D009270:Naloxone / Q000009:adverse effects*; D009292:Narcotic Antagonists / Q000009:adverse effects*; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000139:chemically induced*; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000628:therapy; D014019:Tissue Donors
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D005283:Fentanyl