Abstract
Nalbuphine hydrochloride,an agonist— antagonist opioid, is reported to reverse the respiratory depression of moderate doses offentanyl (20 μg · kg−1) and still provide good analgesia. We report four patients having abdominal aortic aneurysm repair in which we attempted to reverse the respiratory depression of large doses of fentanyl (50–75 μg · kg−1) with nalbuphine (0.3 mg · kg−1, 0.1 mg · kg−1 or 0.05 mg · kg−1). Nalbuphine reversed respiratory depression in all four patients and the respiratory rate increased from 10 to 23 breaths per minute, end-tidal CO2 decreased from 7.0 ± 0.3 per cent to 5.6 ± 0.7 per cent, and peak inspiratory pressure after 0.1 seconds increased from 4 ± 1.4 to 13 ± 2.6 mmHg. However, hypertension, increased heart rate, and significant increase in analogue pain scores accompanied reversal of respiratory depression. Agitation, nausea, vomiting, and cardiac dysrhythmias also were observed frequently. We do not recommend the use of nalbuphine to facilitate early extubation of the trachea after large doses of fentanyl for abdominal aortic surgery.
Résumé
On dit que l’hydrochlorure de nalbuphine, un morphinique agonisteantagoniste, peut contrecarrer la dépression respiratoire induite par des doses moyennes de fentanyl (20 μg · kg−1) tout en préservant l’analgésie. Nous avons injecté de. la nalbuphine (0,3, 0,1 ou 0,05 mg · kg−1) dans quatre cas de résection d’anévrysme de l’aorte abdominale où on avail utilisé de bonnes doses de fentanyl (50–75 μg · kg−1). La dépression respiratoire est disparue dans chaque cas, la fréquence respiratoire passant de 10 à 23 respiration/minute, le CO2 en fin d’expiration de 7,0 ± 0,3 à 5,6 ± 0,7 pour cent et la pression inspiratoire maximale à 0,1 seconde augmentant de 4 ± 1,4 à 13 ± 2,6 mmHg. Toutefois, cela s’est accompagné d’hypertension et d’une augmentation du pouls et de la douleur à l’échelle analogique et souvent, d’agitation, de nausées, de vomissements et d’arythmies cardiaques. Dans les cas de chirurgie de l’aorte abdominale où on a utilisé du fentanyl à dose élevée, il n’est pas approprié d’employer la nalbuphine pour favoriser une extubation précoce de la trachée.
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Blaise, G.A., Nugent, M., McMichan, J.C. et al. Side effects of nalbuphine while reversing opioid-induced respiratory depression: report of four cases. Can J Anaesth 37, 794–797 (1990). https://doi.org/10.1007/BF03006539
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DOI: https://doi.org/10.1007/BF03006539