Klausner J M, Caspi J, Lelcuk S, Khazam A, Marin G, Hechtman H B, Rozin R R
Department of Surgery, Hadassah (Rokach) Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel.
Arch Surg. 1988 Jan;123(1):66-7. doi: 10.1001/archsurg.1988.01400250076013.
A delayed effect of fentanyl used for anesthesia may be respiratory distress several hours after surgery. The findings are muscular rigidity, fall in chest wall compliance, hypoventilation, respiratory acidosis, and hypotension. In the past, to our knowledge, this complication was exclusively reported in patients undergoing cardiac surgery, when large fentanyl dosages are employed. This article describes three general surgical patients in whom respiratory distress developed three to five hours following colon surgery when a moderate dose of fentanyl citrate, 55 to 75 micrograms/kg, was used. Initially, all patients had a normal recovery from anesthesia. Later, respiratory distress was successfully treated with a fentanyl antagonist and ventilatory assistance. This delayed toxic phenomenon is thought to be due to the reentry of fentanyl into plasma from deposits in adipose tissue, muscle, and the gastrointestinal tract, leading to a secondary rise in the plasma concentration. It is more likely to be encountered when hypothermia, rewarming, and acidosis are present in the postoperative period. This life-threatening complication is treacherous, since it may occur when the patient has been transferred to the surgical ward and is less closely monitored.
用于麻醉的芬太尼的延迟效应可能是术后数小时出现呼吸窘迫。表现为肌肉僵硬、胸壁顺应性下降、通气不足、呼吸性酸中毒和低血压。据我们所知，过去这种并发症仅在接受心脏手术且使用大剂量芬太尼的患者中报道。本文描述了3例普通外科患者，他们在结肠手术后3至5小时出现呼吸窘迫，当时使用了中等剂量的枸橼酸芬太尼，55至75微克/千克。最初，所有患者麻醉恢复正常。后来，呼吸窘迫通过芬太尼拮抗剂和通气辅助成功得到治疗。这种延迟性毒性现象被认为是由于芬太尼从脂肪组织、肌肉和胃肠道的沉积物重新进入血浆，导致血浆浓度二次升高。术后出现体温过低、复温和酸中毒时更易发生这种情况。这种危及生命的并发症很凶险，因为它可能在患者已转入外科病房且监测不那么严密时发生。
