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Anesth Analg 2005;101:389-395
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000156563.25878.19

ANESTHETIC PHARMACOLOGY

Preoperative "Fentanyl Challenge" as a Tool to Estimate Postoperative Opioid Dosing in Chronic Opioid-Consuming Patients

Jennifer J. Davis, MD, Jeffrey D. Swenson, MD, Robert H. Hall, BS, Jeffrey D. Dillon, MD, Ken B. Johnson, MD, Talmage D. Egan, MD, Nathan L. Pace, MD, MStat, and Su-Yi Niu, PhD

Department of Anesthesiology at the University of Utah Medical Center, Salt Lake City, Utah

Address correspondence to Jennifer J. Davis, MD, Department of Anesthesiology, University of Utah Medical Center, 30 North 1900 East, Room 3C 444, Salt Lake City, UT 84132. Address e-mail to jennifer.davis{at}hsc.utah.edu.

When opioids are used for postoperative pain control, it is useful to define the dose-response relationship for analgesia and respiratory depression. We studied 20 chronically opioid-consuming patients having elective multilevel spine fusion. Preoperatively, each patient received a fentanyl infusion of 2 µg · kg–1 · min–1 until the respiratory rate was <5 breaths/min. Pharmacokinetic simulations were used to estimate the effect site concentration at the time of respiratory depression and to predict the patient-controlled analgesia settings that would provide an effect-site fentanyl concentration that was 30% of the concentration associated with respiratory depression. Postoperatively, patient-controlled analgesia settings were adjusted to achieve 2–3 demand doses per hour. At steady-state patient-controlled analgesia settings, arterial blood gases and plasma fentanyl levels were measured. Sixteen patients required no adjustment or one patient-controlled analgesia adjustment. The median arterial Pco2 level was 41 mm Hg and the interquartile range was 39–46 mm Hg. Plasma fentanyl levels demonstrated a significant correlation to the estimated effect-site concentration associated with respiratory depression determined during the preoperative fentanyl challenge. A preoperative fentanyl challenge used with pharmacokinetic simulations may be a useful tool to individualize the administration of analgesics to chronically opioid-consuming patients.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.