• Anesthesia and analgesia · Dec 2003

    Case Reports

    Preoperative fentanyl infusion with pharmacokinetic simulation for anesthetic and perioperative management of an opioid-tolerant patient.

    • Jennifer J Davis, Kenward B Johnson, Talmage D Egan, Daniel P Vezina, Timothy E Snell, and Jeffrey D Swenson.
    • Department of Anesthesiology, University of Utah Medical Center, Salt Lake City, Utah 84132, USA. jbirddavis68@yahoo.com
    • Anesth. Analg. 2003 Dec 1;97(6):1661-2.

    UnlabelledFor opioid-tolerant patients, conventional patient-controlled analgesia dosing may be ineffective. We present a cardiac surgery patient with a history of significant opioid tolerance and prior episodes of severe postoperative pain. Using the patient's response to a large-dose fentanyl infusion in conjunction with a pharmacokinetic simulation, effective intraoperative and postoperative fentanyl plasma concentrations were achieved.ImplicationsA preinduction fentanyl infusion used in conjunction with pharmacokinetic simulation can be a useful tool for assessing individual limits of opioid tolerance, as well as determining an appropriate dose for acute pain management in opioid-tolerant patients.

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