Severe respiratory depression and sedation with transdermal fentanyl: four case studies
@article{Regnard2003SevereRD, title={Severe respiratory depression and sedation with transdermal fentanyl: four case studies}, author={Claud Regnard and Anne Pelham}, journal={Palliative Medicine}, year={2003}, volume={17}, pages={714 - 716} }
We have seen four patients with advanced cancer on transdermal (TD) fentanyl (Durogesic) develop delayed and severe respiratory depression. These cases occurred within a two-year period; three in a 15-bed specialist palliative care unit and the fourth in a nearby teaching hospital. The four cases are of concern since past and recent studies have suggested that respiratory depression with TD fentanyl is uncommon and mild. ,2
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References
SHOWING 1-10 OF 18 REFERENCES
Inefficacy of high‐dose transdermal fentanyl in a patient with neuropathic pain a case report
- MedicineEuropean journal of pain
- 2001
The case of a 58‐year‐old female with neuropathic pain using increasing transdermal fentanyl dosages to a maximum dose of 3400 μg/h resulting in fentanyl plasma levels of 173 ng/ml is described.
Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl
- MedicineActa anaesthesiologica Scandinavica
- 1995
This study made a longterm (72 hours) evaluation of the efficacy and possible side‐effects of transdermal delivery of fentanyl (TTS‐system) for post‐operative pain relief.
Transdermal fentanyl against postoperative pain.
- MedicineActa anaesthesiologica Belgica
- 1989
60 patients (ASA class I-II) undergoing knee arthrotomy received in a double blind fashion, a transdermal drug delivery system, containing either fentanyl (delivery rate of 75 micrograms/hour)--Fentanyl TTS--or placebo, with no statistical significant difference between both groups (fentanyl or placebo).
Long-term observations of patients receiving transdermal fentanyl after a randomized trial.
- Medicine, BiologyJournal of pain and symptom management
- 2001
Transdermal fentanyl for the management of cancer pain: a survey of 1005 patients
- MedicinePalliative medicine
- 2001
Transdermal fentanyl can be recommended for treatment of moderate to severe cancer pain and probably may even be used as a first-line drug on step 3 of the World Health Organization recommendations in selected patient groups.
Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket.
- MedicineAnesthesia and analgesia
- 2001
IMPLICATIONS
This case describes the narcotic overdose associated with the use of a fentanyl transdermal patch in a patient being rewarmed with an external warming blanket during surgery. The…
A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy. Analgesic, respiratory, and pharmacokinetic effects.
- Medicine
- 1994
BackgroundA randomized, double-blind, placebo-controlled trial was conducted to assess the analgesic, pharmacokinetic, and clinical respiratory effects of 72-h application of two transdermal fentanyl…
Biphasic Respiratory Depression after Fentanyl—Droperidol or Fentanyl Alone Used to Supplement Nitrous Oxide Anesthesia
- MedicineAnesthesiology
- 1976
Either fentanyl or Innovar was administered to supplement nitrous oxide anesthesia for operations on 29 patients, and full recovery appeared to be more rapid with Innovar than with fentanyl alone.
Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo.
- MedicineJournal of clinical anesthesia
- 1995
A Double‐blind, Placebo‐controlled Trial of Transdermal Fentanyl after Abdominal Hysterectomy Analgesic, Respiratory, and Pharmacokinetic Effects
- MedicineAnesthesiology
- 1994
Application of TTSF patches 2 h preoperatively is associated with moderate supplementary opioid requirements for analgesia in the early postoperative period and ongoing opioid supplementation for at least 72 h and a high incidence of respiratory depression requiring intensive monitoring, oxygen supplementation, and removal of the T TSF patches.