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Prospective sonographic evaluation of fentanyl side effects on the neonatal gallbladder
Beate Schmidt1, Bernhard Roth, Hartmut Stützer
1Department of Neonatology, Children's Hospital, University of Cologne, Kerpenerstrasse 62, 50937, Cologne, Germany. beate.schmidt@uk-koeln.de
Insights
Continuous fentanyl infusions in neonates did not significantly affect gallbladder volume or cause major gastrointestinal issues. This suggests fentanyl is safe for the biliary system and intestines in ventilated infants.
Area of Science:
- Neonatal intensive care
- Pediatric anesthesiology
- Gastroenterology
Background:
- Opioid use in neonates is increasing for pain and stress management.
- Potential adverse effects include constipation and biliary pressure changes.
- The impact of fentanyl on neonatal gallbladder dynamics requires investigation.
Purpose of the Study:
- To evaluate the effect of continuous intravenous fentanyl infusion on neonatal gallbladder volume.
- To assess potential gastrointestinal side effects associated with fentanyl in mechanically ventilated neonates.
Main Methods:
- A prospective study of 40 mechanically ventilated neonates receiving total parenteral nutrition and midazolam sedation.
- 20 neonates received continuous fentanyl infusions (0.5-2 microg kg(-1) h(-1)), while 20 served as controls.
- Gallbladder volume was calculated using sonographic measurements and the ellipsoid method; meconium release and bilirubin levels were also monitored.
Main Results:
- Fentanyl administration was not linked to gallbladder sludge, stones, hydrops, hyperbilirubinemia, or delayed meconium release.
- No significant differences were observed in neonatal gallbladder length, width, or volume between the fentanyl and control groups.
- Statistical analysis showed no significant impact of fentanyl on gallbladder dimensions (P > 0.05 for all measurements).
Conclusions:
- Continuous fentanyl infusion did not cause major complications in the biliary system or intestines of ventilated neonates.
- Routine sonographic gallbladder monitoring may not be necessary during fentanyl treatment.
- Further research is needed to fully understand potential adverse gastrointestinal effects of fentanyl in this population.
Objective:
In an effort to minimise the stress and pain of mechanically ventilated neonates, the application of opioids has increased markedly. Abdominal adverse effects of opioid analgesics are constipation and increased pressure in the biliary system. Our aim was to evaluate the impact of continuous intravenous infusion of fentanyl on the volume of the neonatal gallbladder and to assess potential gastrointestinal side effects.
Methods:
We prospectively matched pairs of 40 mechanically ventilated neonates (28-42 gestational weeks) under total parenteral nutrition and midazolam sedation. One group (20 patients) received continuous fentanyl infusions (dose 0.5-2 microg kg(-1) h(-1)) the other group (20 patients) served as controls. Sonographic measurements of gallbladder length, depth and width were performed to calculate gallbladder volume using the ellipsoid method. Repeated ultrasound images, date of meconium release and serum bilirubin levels were documented.
Results:
Fentanyl application was not associated with gallbladder sludge/stones, gallbladder hydrops, hyperbilirubinemia or prolonged meconium release. Neonatal gallbladder length, width and volume did not differ significantly (data expressed as mean, standard deviation, median, interquartile range: length (cm) 3.16+/-0.68, 3.3, 0.675 vs 3.06+/-0.62, 3.3, 1.1; P=0.645; width (cm) 1.02+/-0.23, 1.0, 0.28 vs 0.89+/-0.27, 0.9, 0.38, P=0.12; volume (cm(3)) 1.52+/-0.67, 1.7, 0.86 vs 1.22+/-0.77, 1.09, 1.19, P=0.20).
Conclusion:
In our study fentanyl caused no major complications in the biliary system and intestine of ventilated preterm and term neonates. Sonographic investigations of the gallbladder under fentanyl treatment may be dispensable. Further investigations are required to assess adverse gastrointestinal effects.
