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Restlessness and Shivering after Naloxone Reversal of Fentanyl‐supplemented Anaesthesia
Author(s) -
Tammisto T.,
Tigerstedt I.
Publication year - 1979
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1979.tb01421.x
Subject(s) - medicine , shivering , fentanyl , anesthesia , (+) naloxone , opioid , receptor
To study the significance of normalization of ventilatory or thermal homeostasis during naloxone reversal, 95 patients were given naloxone after thiopental‐N 2 O‐O 2 ‐relaxant anaesthesia supplemented with fentanyl (6 μg/kg/h). If naloxone 0.16 mg was given to combat postoperative apnoea during hypercapnia (end tidal carbon dioxide concentration (ETco 2 ) 8%), minute ventilation and respiratory rate were significantly higher during the first minutes as compared to the normo‐capnic patients. Shivering occurred in 44% in the hypercapnic group, as compared to about 30% if naloxone was given during normocapnia (ETco 2 5%). Postoperative pain and restlessness were significantly increased in the hypercapnic group. During normocapnia, untoward reactions were less frequent (40%) if naloxone was given in smaller increments (0.08+0.08 mg) rather than in one dose (0.16 mg) (72%). This was mainly due to nausea (8% compared to 32%). The incidence and severity of shivering showed a positive correlation to the duration of anaesthesia (r = 0.42) and to the total amount of fentanyl (r = 0.32), but not to the actual postoperative oesophageal temperature (r=—0.13). The results indicate that though untoward reactions after naloxone reversal are aggravated by naloxone‐induced normalization of deranged homeostatic mechanisms, their aetiology probably should be sought in an acute abstinence syndrome.