RT Book, Section
A1 Butterworth IV, John F.
A1 Mackey, David C.
A1 Wasnick, John D.
SR Print(0)
ID 1161426602
T1 Analgesic Agents
T2 Morgan & Mikhail's Clinical Anesthesiology, 6e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259834424
LK accessmedicine.mhmedical.com/content.aspx?aid=1161426602
RD 2024/04/20
AB KEY  CONCEPTS  The  accumulation  of  morphine  metabolites  (morphine  3-glucuronide  and  morphine  6-glucuronide)  in  patients  with  kidney  failure  has  been  associated  with  narcosis  and  ventilatory  depression.  Rapid  administration  of  larger  doses  of  opioids  (particularly  fentanyl,  sufentanil,  remifentanil,  and  alfentanil)  can  induce  chest  wall  rigidity  severe  enough  to  make  ventilation  with  bag  and  mask  nearly  impossible.  Prolonged  dosing  of  opioids  can  produce  “opioid-induced  hyperalgesia,”  in  which  patients  become  more  sensitive  to  painful  stimuli.  Infusion  of  large  doses  of  (in  particular)  remifentanil  during  general  anesthesia  can  produce  acute  tolerance,  in  which  much  larger  than  usual  doses  of  opioids  are  required  for  postoperative  analgesia.  The  neuroendocrine  stress  response  to  surgery  is  measured  in  terms  of  the  secretion  of  specific  hormones,  including  catecholamines,  antidiuretic  hormone,  and  cortisol.  Large  doses  of  opioids  inhibit  the  release  of  these  hormones  in  response  to  surgery  more  completely  than  volatile  anesthetics.  Aspirin  is  unique  in  that  it  irreversibly  inhibits  COX-1  by  acetylating  a  serine  residue  in  the  enzyme.  The  irreversible  nature  of  its  inhibition  underlies  the  nearly  1-week  persistence  of  its  clinical  effects  (eg,  inhibition  of  platelet  aggregation  to  normal)  after  drug  discontinuation.