Journal of Anesthesia

, Volume 21, Issue 3, pp 417–419

Central neurogenic hyperventilation treated with intravenous fentanyl followed by transdermal application

  • Yushi U. Adachi
  • Hideki Sano
  • Matsuyuki Doi
  • Shigehito Sato
Clinical reports

Abstract

Central neurogenic hyperventilation (CNH) is a rare clinical condition that is sometimes difficult to treat. We report a 51-year-old female patient who was successfully treated with intravenous fentanyl followed by transdermal fentanyl. She had a transient epileptic episode with a temporary loss of consciousness. Immediately before her admission to the intensive care unit (ICU), her PaCO2 and pH were 6.7 mmHg and 7.64, respectively. Rebreathing from a paper bag and the intravenous administration of diazepam failed to improve the decreased PaCO2. Therefore, we administered intravenous fentanyl, at the rate of 50 µg·h−1. Two days after her admission to the ICU, the PaCO2 had increased gradually to 22.9 mmHg, and the pH to 7.50. Although infiltration of recurrent lymphoma to the brain became apparent, she remained active, without epilepsy or loss of consciousness, in a general ward for 1 month with transdermal fentanyl, treatment until she again became drowsy; she died on hospital day 58. Transdermal fentanyl seems to be a good palliative measure to treat CNH in patients who have advanced neoplasms.

Key words

Central neurogenic hyperventilation Fentanyl patch Durotep 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Plum, F, Swanson, AG 1959Central neurogenic hyperventilation in manArch Neurol Psychiatry81535549Google Scholar
  2. 2.
    Tarulli, AW, Lim, C, Bui, JD, Saper, CB, Alexander, MP 2005Central neurogenic hyperventilation. A case report and discussion of pathophysiologyArch Neurol6216321634PubMedCrossRefGoogle Scholar
  3. 3.
    Pauzner, R, Mouallem, M, Sadeh, M, Tadmor, R, Farfel, Z 1989High incidence of primary cerebral lymphoma in tumor-induced central neurogenic hyperventilationArch Neurol46510512PubMedGoogle Scholar
  4. 4.
    Sakamoto, T, Kokubo, M, Sasai, K, Chin, K, Takahashi, JA, Nagata, Y, Hiraoka, M 2001Central neurogenic hyperventilation with primary cerebral lymphoma: a case reportRadiat Med19209213PubMedGoogle Scholar
  5. 5.
    Shahar, E, Postovsky, S, Bennett, O 2004Central neurogenic hyperventilation in a conscious child associated with glioblastoma multiformePediatr Neurol30287290PubMedCrossRefGoogle Scholar
  6. 6.
    Gaviani, P, Gonzalez, RG, Zhu, JJ, Batchelor, TT, Henson, JW 2005Central neurogenic hyperventilation and lactate production in brainstem gliomaNeurology64166167PubMedCrossRefGoogle Scholar
  7. 7.
    Shibata, Y, Meguro, K, Narushima, K, Shibuya, F, Doi, M, Kikuchi, Y 19921992) Malignant lymphoma of the central nervous system presenting with central neurogenic hyperventilationJ Neurosurg76696700PubMedCrossRefGoogle Scholar
  8. 8.
    Johnston, SC, Slingh, V, Ralston, HJ,3rd, Gold, WM 2001Chronic dyspnea and hyperventilation in an awake patient with small subcortical infarctsNeurology5721312133PubMedGoogle Scholar
  9. 9.
    Rottenberg, DA, Ginos, JZ, Kearfott, KJ, Junck, L, Dhawan, V, Jarden, JO 1985In vivo measurement of brain tumor pH using [11C] DMO and positron emission tomographyAnn Neurol177079PubMedCrossRefGoogle Scholar
  10. 10.
    Somjen, GG, Allen, BW, Balestrino, M, Aitken, PG 1987Pathophysiology of pH and Ca2+ in bloodstream and brainCan J Physiol Pharmacol6510781085PubMedGoogle Scholar
  11. 11.
    Sunderrajan, EV, Passamonte, PM 1984Lymphomatoid granulomatosis presenting as central neurogenic hyperventilationChest86634636PubMedGoogle Scholar
  12. 12.
    Jaeckle, KA, Digre, KB, Jones, CR, Bailey, PL, McMahill, PC 1990Central neurogenic hyperventilation: pharmacologic intervention with morphine sulfate and correlative analysis of respiratory, sleep, and ocular motor dysfunctionNeurology4017151720PubMedGoogle Scholar

Copyright information

© JSA 2007

Authors and Affiliations

  • Yushi U. Adachi
    • 1
  • Hideki Sano
    • 1
  • Matsuyuki Doi
    • 1
  • Shigehito Sato
    • 1
  1. 1.Intensive Care Unit of University HospitalHamamatsu University School of MedicineShizuokaJapan

Personalised recommendations