PMID- 30982564
OWN - NLM
STAT- MEDLINE
DCOM- 20190603
LR  - 20190603
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 122
IP  - 6
DP  - 2019 Jun
TI  - Effects of low-dose intraoperative fentanyl on postoperative respiratory 
      complication rate: a pre-specified, retrospective analysis.
PG  - e180-e188
LID - S0007-0912(19)30218-1 [pii]
LID - 10.1016/j.bja.2019.03.017 [doi]
AB  - BACKGROUND: Fentanyl is one of the most frequently administered intraoperative 
      drugs and may increase the risk of postoperative respiratory complications 
      (PRCs). METHODS: We performed a pre-specified analysis of 145 735 adult 
      non-cardiac surgical cases under general anaesthesia. Using multivariable 
      logistic regression, we evaluated the association of intraoperative fentanyl dose 
      and PRCs within 3 days after surgery (defined as reintubation, respiratory 
      failure, pneumonia, pulmonary oedema, or atelectasis). We examined effect 
      modification by patient characteristics, surgical site, and anaesthetics used. 
      RESULTS: PRCs within 3 days after surgery occurred in 18 839 (12.9%) patients. In 
      comparison with high intraoperative fentanyl doses [median: 3.85; inter-quartile 
      range (IQR): 3.42-4.50 mug kg(-1), quartile 4 (Q4)], low intraoperative fentanyl 
      dose [median: 0.80, IQR: 0.00-1.14 mug kg(-1), quartile 1 (Q1)] was significantly 
      associated with lower odds of PRCs [Q1 vs Q4: 10.9% vs 16.2%; adjusted odds ratio 
      (aOR) 0.79; 95% confidence intervals (CI) 0.75-0.84; P<0.001; adjusted absolute 
      risk difference (aARD) -1.7%]. This effect was augmented by thoracic surgery (P 
      for interaction <0.001; aARD -6.2%), high doses of inhalation anaesthetics (P for 
      interaction=0.016; aARD -2.2%) and neuromuscular blocking agents (NMBAs) (P for 
      interaction=0.001; aARD -3.4%). Exploratory analysis demonstrated that compared 
      with no fentanyl, low-dose fentanyl was associated with lower rates of PRCs 
      (decile 2 vs decile 1: aOR 0.82, CI 0.75-0.89, P<0.001). CONCLUSIONS: 
      Intraoperative low-dose fentanyl (about 60-120 mug for a 70 kg patient) was 
      associated with lower risk of postoperative respiratory complications compared 
      with both no fentanyl and high-dose fentanyl. Beneficial effects of low-dose 
      fentanyl were magnified in specific patient subgroups. CLINICAL TRIAL 
      REGISTRATION: NCT03198208.
CI  - Copyright (c) 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Friedrich, S
AU  - Friedrich S
AD  - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess 
      Medical Center, Harvard Medical School, Boston, MA, USA; Department of 
      Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and 
      Harvard Medical School, Boston, MA, USA.
FAU - Raub, D
AU  - Raub D
AD  - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess 
      Medical Center, Harvard Medical School, Boston, MA, USA; Department of 
      Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and 
      Harvard Medical School, Boston, MA, USA.
FAU - Teja, B J
AU  - Teja BJ
AD  - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess 
      Medical Center, Harvard Medical School, Boston, MA, USA.
FAU - Neves, S E
AU  - Neves SE
AD  - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess 
      Medical Center, Harvard Medical School, Boston, MA, USA.
FAU - Thevathasan, T
AU  - Thevathasan T
AD  - Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General 
      Hospital and Harvard Medical School, Boston, MA, USA.
FAU - Houle, T T
AU  - Houle TT
AD  - Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General 
      Hospital and Harvard Medical School, Boston, MA, USA.
FAU - Eikermann, M
AU  - Eikermann M
AD  - Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess 
      Medical Center, Harvard Medical School, Boston, MA, USA; Universitatsklinikum 
      Essen, Essen, Germany. Electronic address: meikerma@bidmc.harvard.edu.
LA  - eng
SI  - ClinicalTrials.gov/NCT03198208
PT  - Journal Article
DEP - 20190411
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - 0 (Analgesics, Opioid)
RN  - UF599785JZ (Fentanyl)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Analgesics, Opioid/*administration & dosage/adverse effects
MH  - Anesthesia, General/methods
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Fentanyl/*administration & dosage/adverse effects
MH  - Humans
MH  - Intraoperative Period
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/chemically induced/*prevention & control
MH  - Registries
MH  - Respiration Disorders/chemically induced/*prevention & control
MH  - Retrospective Studies
MH  - Young Adult
OTO - NOTNLM
OT  - analgesics
OT  - fentanyl
OT  - opioid
OT  - pneumonia
OT  - postoperative complications
OT  - respiratory failure
OT  - respiratory tract diseases
EDAT- 2019/04/16 06:00
MHDA- 2019/06/04 06:00
CRDT- 2019/04/16 06:00
PHST- 2018/11/07 00:00 [received]
PHST- 2019/02/24 00:00 [revised]
PHST- 2019/03/15 00:00 [accepted]
PHST- 2019/04/16 06:00 [pubmed]
PHST- 2019/06/04 06:00 [medline]
PHST- 2019/04/16 06:00 [entrez]
AID - S0007-0912(19)30218-1 [pii]
AID - 10.1016/j.bja.2019.03.017 [doi]
PST - ppublish
SO  - Br J Anaesth. 2019 Jun;122(6):e180-e188. doi: 10.1016/j.bja.2019.03.017. Epub 
      2019 Apr 11.