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[Epidural fentanyl delayed emergence from anesthesia].
Noriyuki Shintani1, Tadahiko Ishiyama, Masaki Kume
1Department of Anesthesia, Kofu Municipal Hospital, Kofu 400-0832.
Masui. the Japanese Journal of Anesthesiology
|February 21, 2012
Summary
An elderly patient experienced prolonged anesthesia recovery due to epidural fentanyl, suggesting a potential hypersensitivity. Patient-controlled epidural anesthesia might offer a safer alternative for similar cases.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- An 83-year-old male with hypertension and atrial fibrillation underwent cholecystectomy.
- Epidural anesthesia was initiated with mepivacaine, followed by general anesthesia with propofol, remifentanil, and nitrous oxide.
Observation:
- A bolus of epidural mepivacaine and fentanyl was administered, followed by an infusion of ropivacaine, fentanyl, and droperidol.
- Postoperatively, the patient developed atrial fibrillation, requiring electrocardioversion.
- Following anesthetic discontinuation, the patient exhibited delayed emergence from anesthesia despite spontaneous breathing.
Findings:
- The patient's delayed recovery from anesthesia was attributed to epidurally administered fentanyl, possibly due to hypersensitivity.
- Stopping the epidural infusion led to the patient's eventual recovery.
- Restarting the epidural infusion later caused the patient to fall asleep again.
Implications:
- This case highlights the potential for delayed recovery from anesthesia secondary to epidural fentanyl administration.
- Individual patient sensitivity to fentanyl should be considered in anesthetic management.
- Patient-controlled epidural anesthesia could be a valuable alternative for managing pain and anesthesia in susceptible patients.
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