Fentanyl
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Autonomic dysfunction and abdominal distention: case report A 38-year-old man developed autonomic dysfunction and abdominal distention during treatment with fentanyl for induction of anaesthesia. The man was brought to the emergency department on 15 October 2017 after severe abdominal pain for one day due to chronic alcohol intake and a recent binge of 500ml of spirits 3 days prior. His medical history included chronic liver disease due to alcohol abuse, smoking, obesity, drug use and schizophrenia. Following examinations, he was diagnosed with alcohol-induced acute pancreatitis and abdominal compartment syndrome with associated hepatic dysfunction and acute kidney injury. Then, his condition deteriorated. He was normotensive and afebrile but tachycardic despite aggressive fluid resuscitation with sodium lactate. Then, he was transferred to the ICU for fluid resuscitation. Due to his deteriorated condition, he was intubated. Rapid-sequence induction was performed with low dose fentanyl [dosage and route not stated], rocuronium bromide and ketamine. Following induction, he developed autonomic dysfunction leading to bradycardia, cardiac arrest, pulseless electrical activity and abdominal distention due to increased vagal tone secondary to fentanyl-induced symphatholysis and exaggerated parasympathetic response [duration of treatment to reactions onsets not stated]. The man received treatment with adrenaline, atropine and normal saline solution along with cardiopulmonary resuscitation. After 5 minute following 3 rounds of cardiopulmonary resuscitation, his spontaneous circulation returned to normal. Author comment: "Rapid-sequence induction was performed with low dose fentanyl. . ." "The [pulseless electrical activity] arrest post-induction was likely secondary to raised [intra-abdominal pressure] impeding venous return, as well as autonomic dysfunction from fentanyl-induced sympatholysis, and abdominal distension causing increased vagal tone and an exaggerated parasympathetic response." Lee AHH, et al. Severe pancreatitis complicated by abdominal compartment syndrome managed with decompressive laparotomy: a case report. BMC Surgery 19: 113, No. 1, 17 Aug 2019. Available from: URL: http://doi.org/10.1186/ 803443121 s12893-019-0575-8 - Australia
0114-9954/20/1785-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 4 Jan 2020 No. 1785
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