Abstract
Several cases of recurrent respiratory depression progressing to apnoea and unconsciousness after apparent recovery from sufentanil have been reported recently. Alfentanil has the shortest elimination half-time of the narcotics used in anaesthesia, suggesting that it should be the least likely to cause postoperative respiratory depression. A case of recurrent unconsciousness and respiratory arrest after apparent recovery from alfentanilisofluranenitrous oxide anaesthesia is reported. A total dose of 137 μg · kg-1 alfentanil was given over a 3.25-hr period to a 45-year-old female undergoing partial gastrectomy. Naloxone, 0.16mg IV, rapidly restored spontaneous ventilation and consciousness. This case demonstrates that apnoea and unconsciousness can also recur after apparent recovery from alfentanil. Recovery room personnel should be aware of this phenomenon. Earlier detection may permit treatment before apnoea occurs. Patients given narcoticsupplemented anaesthesia should be monitored by capnography andlor pulse oximetry in the early postoperative period.
Résumé
Plusieurs cas de dépression respiratoire tardives amenant une apnée et une perte de connaissance après un rêveil apparent post sufentanil ont été rapportés récemment. L’alfentanil a la demivie d’élimination la plus courte parmi les narcotiques utilisés en anesthésie suggérant qu’il est moins probable d’amener une dépression respiratoire en période postopératoire. Un cas de perte de connaissance et d’arrêt respiratoire après réveil apparent d’une anesthésie à l’alfentanilisofluraneprotoxyde d’azote est rapporté. Une dose totale de 137 μg · kg-1 d’alfentanil a été administrée pour une période de 3,25 h à une femme de 45 ans subissant une gastrectomie. Du naloxone 0,16 mg IV fut administré et ceci a restauré la ventilation spontanée et la conscience. Ce cas démontre que l’apnée et l’inconscience peuvent aussi survenir après réveil apparent avec l’alfentanil. Le personnel de la salle de réveil doit être conscient de ce phénomème. Une détection précoce permet le traitement avant que l’apnée survienne. les patients ayant reçu des narcotiques en supplément doivent être surveillés par un capnographe et/ou un saturomètre de pouls dans la période postopératoire.
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Hudson, R.J. Apnoea and unconsciousness after apparent recovery from alfentanil-supplemented anaesthesia. Can J Anaesth 37, 255–257 (1990). https://doi.org/10.1007/BF03005480
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DOI: https://doi.org/10.1007/BF03005480