Abstract
The purpose of this study was to investigate the state of wakefulness during the induction of anesthesia with high-dose fentanyl using the isolated forearm technique. Ten patients scheduled for elective cardiovascular surgery were premedicated with morphine (0.15 mg/kg) and scoploamine (0.3/2-0.4 mg) intramuscularly one hour before induction. The induction of anesthesia was performed by intravenous administration of 100 /gmg/kg of fentanyl in 15 min or over. The pneumatic tourniquet applied on the left upper arm was inflated to 220/2-240 mmHg after 10 /gmg/kg of fentanyl was given and then pancuronium was administered. Verbal commands were given to the patient after 25, 50, 75 and 100 /gmg/kg of fentanyl was administered. Eight patients out of 10 responded to the verbal commands after administration of 25 /gmg/kg of fentanyl. Six patients also responded after administration of 100 /gmg/kg of fentanyl and diazepam 5 mg was given to prevent tachycardia and rigidity during endotracheal intubation. Muscle rigidity and tachycardia were noticed in three and four patients respectively. These complications disappeared by diazepam administration.
It was noted that wakefulness frequently occurred during the induction by high-dose fentanyl and oxygen anesthesia. To prevent such wakefulness therefore, it is necessary to use anesthetic supplements which do not cause cardiovascular depression.
Similar content being viewed by others
References
Stanley TH, Webster LR: Anesthetic requirements and cardiovascular effects of fentanyl-oxygen and fentanyl-diazepamoxygen anesthesia in man. Anesth Analg (Cleve) 57:411–416, 1978
Wong KC: Narcotics are not expected to produce unconsciousness and amnesia. (editorial) Anesth Analg 62:625–626, 1983
Mummaneni N, Rao TLK, Montoya A: Awareness and recall with high-dose fentanyl-oxygen anesthesia. Anesth Analg 59:948–949, 1980
Hilgenberg JC: Intraoperative awareness during high-dose fentanyl-oxygen anesthesia. Anesthesiology 54:341–343, 1981
Mark JB, Greenberg LM: Intraoperative awareness and hypertensive crisis during high-dose fentanyl-diazepam-oxygen anesthesia. Anesth Analg 62:698–700, 1983
Tunstall ME: Detecting wakefulness during general anaesthesia for caesarean section. Brit Med J 21:1321, 1977
Lunn JK, Stanley TH, Eisere J, Webster L, Woodward A: High dose fentanyl anesthesia for coronary artery surgery: plasma fentanyl concentrations and influence of nitrous oxide on cardiovascular responses. Anesth Analg 58:390–395, 1979
Blacher RS: On awakening paralyzed during surgery. JAMA 234:67–68, 1975
Comstock MK, Scamman FL, Carter JG, Moyers JR, Stevens WC: Rigidity and hypercarbia on fentanyl-oxygen induction. Anesthesiology 51:828, 1979
Comstock MK, Carter JG, Moyers JR, Stevens WC: Rigidity and hypercarbia associated with high dose fentanyl induction of anesthesia. Anesth Analg 60:362–363, 1981
Waller JL, Hug CC, Nagle DM, Craver JM: Hemodynamic changes during fentanyloxygen anesthesia for aortocoronary bypass operation. Anesthesiology 55:212–217, 1981
Turstman R, Dubovsky S, Titley R: Auditory perception during general anesthesia-myth or fact? Internat J Clin Exp Hyp 25:88–105, 1977
Frumin MJ, Herekar VR, Jarvik ME: Amnesic actions of diazepam and scopolamin in man. Anesthesiology 45:406–412, 1976
Author information
Authors and Affiliations
About this article
Cite this article
Watanabe, A., Namiki, A., Ujike, Y. et al. Wakefulness during the induction with high-dose fentanyl and oxygen anesthesia. J Anesth 2, 165–169 (1988). https://doi.org/10.1007/s0054080020165
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s0054080020165