Nath Soumya Shankar, Tripathi Mukesh, Pandey Chadrakant, Rao Bhaskar
Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institue of Medical Sciences, Lucknow, India.
Indian J Med Sci. 2009 Feb;63(2):72-5.
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.
一名接受腹腔镜供体肾切除术（LDN）的28岁患者出现芬太尼过量效应，导致术后恢复不佳。使用纳洛酮（200微克）治疗以逆转芬太尼效应，但出现了高血压。患者在2小时后发生肺水肿，需要进行持续气道正压通气的夜间机械通气。LDN管理中规定的容量超负荷用于克服肾移植立即出现的功能不佳，这可能使这位健康的年轻患者在与纳洛酮给药相关的交感神经兴奋期间易发生心力衰竭。作者认为，血管内血容量扩张后用纳洛酮逆转阿片类药物的过量效应会使患者有发生肺水肿的风险。
