Anticonvulsant therapy increases fentanyl requirements during anaesthesia for craniotomy

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
R TempelhoffE L Spitznagel

Abstract

This study was designed to determine whether patients receiving chronic anticonvulsant therapy demonstrate an altered requirement for fentanyl during anaesthesia. Sixty-one patients undergoing craniotomy were studied; 20 controls (MED = 0) who had never received anticonvulsants and 41 epileptics in whom therapeutic plasma concentrations of either one (MED = 1), two (MED = 2), or three (MED = 3) different anticonvulsants were documented. During anaesthesia with 60-70 per cent N2O in O2 and 0.2 per cent isoflurane, a maintenance dose (MD) of fentanyl was administered using a continuous variable-rate IV fentanyl infusion, supplemented by intermittent 50 micrograms IV boluses. In order to define the minimal dosage of fentanyl required, the MD was titrated according to increases or decreases in the heart rate and/or mean arterial pressure exceeding 15 per cent of baseline ward values. A progressively higher fentanyl MD was required in the epileptic patients (MED = 1-4.3 +/- 0.5 microgram.kg-1.hr-1; MED = 2-5.4 +/- 0.6; MED = 3-7.6 +/- 0.6) compared with the control MD (MED = 0-2.6 +/- 0.5) (P less than 0.001). These findings indicate that there appears to be a dose-effect relationship between the number of anticonvulsants received a...Continue Reading

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Citations

May 1, 1993·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·E GignacA W Gelb
Mar 20, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·B BissonnetteV Un
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Mar 1, 1993·Journal of Clinical Anesthesia·W S JellishR Tempelhoff
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Feb 11, 2021·Anesthesiology Clinics·Lane CrawfordLetha Mathews

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