Advertisement
Research Article| Volume 7, ISSUE 3, P615-637, July 1991

Opioids and Other Analgesics

Adverse Effects in the Intensive Care Unit
  • Author Footnotes
    * Pediatric Clinical Pharmacy Specialist
    Marcia L. Buck
    Correspondence
    Address reprint requests to: Marcia L. Buck, PharmD University of Virginia, Children’s Medical Center, Box 274, Charlottesville, VA 22908
    Footnotes
    * Pediatric Clinical Pharmacy Specialist
    Affiliations
    From the University of Virginia, Children's Medical Center, Charlottesvill, Virginia
    Search for articles by this author
  • Author Footnotes
    † Chief, Division of Pharmacology and Critical Cars
    Jeffrey L. Blumer
    Footnotes
    † Chief, Division of Pharmacology and Critical Cars
    Affiliations
    From the University of Virginia, Children's Medical Center, Charlottesvill, Virginia
    Search for articles by this author
  • Author Footnotes
    * Pediatric Clinical Pharmacy Specialist
    † Chief, Division of Pharmacology and Critical Cars
      This paper is only available as a PDF. To read, Please Download here.
      Medications for pain relief are an important component of therapy for intensive care patients. Opioids, the most commonly used analgesics in the ICLJ setting, are associated with a large number of adverse effects that are related to their binding properties at opioid-receptor subtypes. Other analgesics, such as ketamine and nonsteroidal anti-inflammatory agents, may cause fewer cardiovascular and respiratory effects, but lead to other unwanted effects in ICU patients. In addition to a review of analgesic-associated adverse effects and drug interactions, guidelines for anticipating and monitoring these agents are presented.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Critical Care Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abboud T.K.
        • Afrasiabi A
        • Davidson J
        • et al.
        Prophylactic oral naltrexone with epidural morphine: Effect on adverse reactions and ventilatory responses to carbon dioxide.
        Anesthesiology. 1990; 72: 233-237
        • Adler M.W.
        • Geller E.B.
        • Rosow C.E.
        • et al.
        The opioid system and temperature regulation.
        Ann Rev Pharmacol Ther. 1988; 28: 429-449
        • Aghajanian G.K.
        Tolerance of locus coeruleus neurones to morphine and suppression of withdrawal response by clonidine.
        Nature. 1978; 276: 186-189
        • Ahtee L
        • Attila L.M.J
        Cerebral monoamine neurotransmitters in opioid withdrawal and dependence.
        Med Biol. 1987; 65: 113-119
        • Aitkenhead A.R.
        Analgesia and sedation in intensive care.
        Br J Anaesth. 1989; 63: 196-206
        • Althaus J.S.
        • Von Voigtlander P.F.
        • DiFazio C.A.
        • et al.
        Effects of U-50488H, a selective k-analgesic, on the minimum anesthetic concentration (MAC) of halothane in the rat.
        Anesth Analg. 1987; 66: 391-394
        • Amoroso P
        • Best C.J.
        Paralytic ileus during ketamine infusion.
        Anaesthesia. 1989; 44: 74
        • Andrews C.J.H
        • Sinclair M
        • Prys-Roberts C
        • et al.
        Ventilatory effects during and after continuous infusion of fentanyl or alfentanil.
        Br J Anaesth. 1983; 55: 211S-216S
        • Arnold J.H.
        • Truog R.D.
        • Hershenson M.B.
        Neonatal abstinence syndrome in infants sedated with fentanyl.
        Anesthesiology. 1989; 71: A218
        • Bailey P.L.
        • Streisand J.B.
        • East K.A.
        • et al.
        Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil.
        Anesth Analg. 1990; 70: 8-15
        • Ben-Shlomo I
        • Abd-el-Khalim H
        • Ezry J
        Midazolam acts synergistically with fentanyl for induction of anaesthesia.
        Br J Anaesth. 1990; 64: 45-47
        • Benedetti C
        Acute pain: A review of its effects and therapy with systemic opioids.
        in: Benedetti C Chapman C.R. Giron G Opioid Analgesia: Recent Advances in Systemic Administration. Raven Press, New York1990: 367-424
        • Benthuysen J.L.
        • Smith N.T.
        • Sanford T.J.
        • et al.
        Physiology of alfentanil-induced rigidity.
        Anesthesiology. 1986; 64: 440-446
        • Benthuysen J.L.
        • Stanley T.H.
        Concerning the possible nature of reported fentanyl seizures.
        Anesthesiology. 1985; 62: 205
        • Bollish S.J.
        • Collins C.L.
        • Kirking D.M.
        • et al.
        Efficacy of patient-controlled versus conventional analgesia for postoperative pain.
        Clin Pharm. 1985; 4: 48-52
        • Bowdle T.A.
        Myoclonus following sufentanil without EEG seizure activity.
        Anesthesiology. 1987; 67: 593-595
        • Bragg C.L.
        Practical aspects of epidural and intrathecal narcotic analgesia in the intensive care setting.
        Heart Lung. 1989; 19: 599-608
        • Bravo L.J.CB
        • Mattie H
        • Spierdijk J
        • et al.
        The effects of ventilation of ketorolac in comparison with morphine.
        Eur J Clin Pharmacol. 1988; 35: 491-494
        • Brian J.E.
        • Seifen A.B.
        Tonic-clonic activity after sufentanil.
        Anesth Analg. 1987; 66: 481
        • Bromage P.R.
        • Camporesi E.M.
        • Durant P.A.C
        • et al.
        Nonrespiratory side effects of epidural morphine.
        Anesth Analg. 1982; 61: 490-495
        • Bruera E
        • Brenneis C
        • Michaud M
        • et al.
        Continuous SC infusion of metoclopramide for treatment of narcotic bowel syndrome.
        Cancer Treat Rep. 1987; 71: 1121-1122
        • Bruera E
        • Miller M.J.
        Non-cardiogenic pulmonary edema after narcotic treatment for cancer pain.
        Pain. 1989; 39: 297-300
        • Caspi J
        • Klausner J.M.
        • Safadi T
        • et al.
        Delayed respiratory depression following fentanyl anesthesia for cardiac surgery.
        Crit Care Med. 1988; 16: 238-240
        • Chang J
        • Fish K.J.
        Acute respiratory arrest and rigidity after anesthesia with sufentanil: A case report.
        Anesthesiology. 1985; 63: 710-711
        • Cheng E.Y.
        • May J
        Nalbuphine reversal of respiratory depression after epidural sufentanil.
        Crit Care Med. 1989; 17: 378-379
        • Christian C.M.
        • Waller J.L.
        • Moldenhauer C.C.
        Postoperative rigidity following fentanyl anesthesia.
        Anesthesiology. 1983; 58: 275-277
        • Coelho J.C.U
        • Runkel N
        • Herfarth C
        • et al.
        Effect of analgesic drugs on the electromyographic activity of the gastrointestinal tract and sphincter of Oddi and on biliary pressure.
        Ann Surg. 1986; 204: 53-58
        • Cohen A.T.
        • Kelly D.R.
        Assessment of alfentanil by intravenous infusion as long-term sedation in intensive care.
        Anaesthesia. 1987; 42: 545-548
        • Conrad K.A.
        • Fagan T.C.
        • Mackie M.J.
        • et al.
        Effects of ketorolac tromethamine on hemostasis in volunteers.
        Clin Pharmacol Ther. 1988; 43: 542-546
        • Crews J.C.
        Epidural opioid analgesia.
        Crit Care Clin. 1990; 6: 315-342
        • Davies G.G.
        • From R
        A blinded study using nalbuphine for prevention of pruritus induced by epidural fentanyl.
        Anesthesiology. 1988; 69: 763-765
        • de Lange S
        • Boscoe M.J.
        • Stanley T.H.
        • et al.
        Comparison of sufentanil-O2 and fentanyl-O2 for coronary artery surgery.
        Anesthesiology. 1982; 56: 112-118
        • Dingledine R
        • Valentino R.J.
        • Bostock E
        • et al.
        Down-regulation of δ but not µ opioid receptors in the hippocampal slice associated with loss of physiological response.
        Life Sci. 1983; 33 (suppl l): 333-336
        • Dobb G.J.
        • Murphy D.F.
        Sedation and analgesia during intensive care.
        Clin Anaesthesiol. 1985; 3: 1055-1085
        • Dundee J.W.
        Twenty-five years of ketamine: A report of an international meeting.
        Anaesthesia. 1990; 45: 159-160
        • Eisendracli S.J.
        • Goldman G.
        • Douglas J
        • et al.
        Meperidine-induced delirium.
        Am J Psychiatry. 1987; 144: 1062-1065
        • Esteroe B
        • Julier M
        • Charleux H
        • et al.
        OompaiIson of ketoiclac, pentazocine, and placebo in treating postoperative pair.
        Cmr Ther Res. 1988; 43: 1173-1182
        • Evans-Prosser C.D.G
        The use of pethidine and morphine in the presence of monoamine oxidase inhibitors.
        Br J Anaesth. 1968; 40: 279-282
        • Fine A
        • Churchill D.N.
        Potentially lethal interaction of cimetidine and morphine.
        Can Med Assoc J. 1981; 124: 1434-1435
        • Finelli P.F.
        Phenytoin and methadone tolerance.
        N Engl J Med. 1976; 294: 227
        • Flacke J.W.
        • Flacke W.E.
        • Bloor B.C.
        • et al.
        Histamine release by four narcotics: A double-blind study in humans.
        Anesth Analg. 1987; 66: 723-730
        • Furst S.R.
        • Weinger M.B.
        Dexmedetomidine, a selective a2-agonist, does not potentiate the cardiorespiratory depression of alfentanil in the rat.
        Anesthesiology. 1990; 72: 882-888
        • Gabrielli A
        • Leoni P
        • Danieli G
        Methotrexate and nonsteroidal anti-inflammatory drugs.
        Br Med J. 1987; 294: 776
        • Gold M.S.
        • Redmond D.E.
        • Kleber H.D.
        Clonidine blocks acute opiate withdrawal symptoms.
        Lancet. 1978; 2: 599-601
        • Goldberg M
        • Ishak S
        • Garcia C
        • et al.
        Postoperative rigidity following sufentanil administration.
        Anesthesiology. 1985; 63: 199-201
        • Guay D.R.P
        • Meatherall R.C.
        • Chalmers J.L.
        • et al.
        Cimetidine alters pethidine disposition in man.
        Br J Clin Pharmacol. 1984; 18: 907-914
        • Guay D.R.P
        • Meatherall R.C.
        • Chalmers J.L.
        • et al.
        Ranitidine does not alter pethidine disposition in man.
        Br J Clin Pharmacol. 1985; 20: 55-59
        • Gungor M
        • Gene E
        • Sagduyu H
        • et al.
        Effect of chronic administration of morphine on primary immune response in mice.
        Experientia. 1980; 36: 1309-1310
        • Hamilton W.K.
        • Cullen S.C.
        Effect of levallorphan tartrate upon opiate-induced respiratory depression.
        Anesthesiology. 1953; 14: 550-554
        • Hasday J.D.
        • Weintraub M
        Propoxyphene in children with iatrogenic morphine depend ence: A review of the literature with two additional cases.
        Am J Dis Child. 1983; 137: 745748
        • Heikkila H
        • Jalonen J
        • Arola M
        • et al.
        Midazolam as adjunct to high-dose fentanyl anaesthesia for coronary artery bypass grafting operation.
        Acta Anaesthesiol Scand. 1984; 28: 683-689
        • Ito Y
        • Ichiyanagi K
        Post-operative pain relief with ketamine infusion.
        Anaesthesia. 1974; 29: 222-229
        • Jaffe J.H.
        • Martin W.R.
        Opioid analgesics and antagonists.
        in: Gilman A.G. Goodman L.S. Rail T.W. The Pharmacological Basis of Therapeutics. ed 7. Macmillan, New York1985: 491-531
        • Jaffe R.S.
        • Coalson D
        Recurrent respiratory depression after alfentanil administration.
        Anesthesiology. 1989; 70: 151-153
        • Jemssi T.P.
        • Capacchione J.F.
        • Benvenga M.J.
        Reversal of opioid-induced muscular rigidity in rats: Evidence for a-2-adrenergic involvement.
        Pharmacol Biochem Behav. 1987; 28: 283289
        • Joachimsson P.O.
        • Hedstrand U
        • Eklund A
        Low-dose ketamine infusion for analgesia during postoperative ventilator treatment.
        Acta Anaesthesiol Scand. 1986; 30: 697-702
        • Johnston R.R.
        • Miller R.D.
        • Way W.L.
        The interaction of ketamine with d-tubocurarine, pancuronium, and succinylcholine in man.
        Anesth Analg. 1974; 53: 496-501
        • Kamaya H
        • Krishna P.R.
        Ketamine addiction.
        Anesthesiology. 1987; 67: 861-862
        • Karlsson J.A.
        • Lanner A.S.
        • Persson C.G.A
        Airway opioid receptors mediate inhibition of cough and reflex bronchoconstriction in guinea pigs.
        J Pharmacol Exp Ther. 1990; 252: 863868
        • Katz R.I.
        • Eide T.R.
        • Hartman A
        • et al.
        Two instances of seizure-like activity in the same patient associated with two different narcotics.
        Anesth Analg. 1987; 67: 289-290
        • Keaveny J.P.
        • Harper N.J.N
        Treatment of epidural morphine-induced pruritus with buprenorphine.
        Anaesthesia. 1989; 44: 691
        • Koren G
        • Zarfin Y
        • Perlman M
        • et al.
        Effects of indomethacin on digoxin pharmacokinetics in preterm infants.
        Pediatr Pharmacol. 1984; 4: 25-30
        • Krane B.D.
        • Kreutz J.M.
        • Johnson D.L.
        • et al.
        Alfentanil and delayed respiratory depression: Case studies and review.
        Anesth Analg. 1990; 70: 557-561
        • Kreek M.J.
        • Garfield J.W.
        • Gutjahr C.L.
        • et al.
        Rifampin-induced methadone withdrawal.
        N Engl J Med. 1976; 294: 1104-1105
        • Lanz E
        • Theiss D
        • Riess W
        • et al.
        Epidural morphine for postoperative analgesia: A double-blind study.
        Anesth Analg. 1982; 61: 236-240
        • Lanza F.L.
        • Karlin D.A.
        • Yee J.P.
        A double-blind placebo controlled endoscopic study comparing the mucosal injury seen with an orally and parenterally administered new nonsteroidal analgesic, ketorolac tromethamine, at therapeutic and supratherapeutic doses.
        Am J Gastroenterol. 1987; 82: 939
        • Leander J.D.
        • Hart J.C.
        • Zerbe R.L.
        k Agonist-induced diuresis: Evidence for stereoselectivity, strain differences, independence of hydration variables and a result of decreased plasma vasopressin levels.
        J Pharmacol Exp Ther. 1987; 242: 33-39
        • Levy J.H.
        • Brister N.W.
        • Shearin A
        • et al.
        Wheal and flare responses to opioids in humans.
        Anesthesiology. 1989; 70: 756-760
        • Linder S
        • Borgeat A
        • Biollaz J
        Meniere-like syndrome following epidural morphine analgesia.
        Anesthesiology. 1989; 71: 782-783
        • Loper K.A.
        • Ready L.B.
        • Dorman B.H.
        Prophylactic transdermal scopolamine patches reduce nausea in postoperative patients receiving epidural morphine.
        Anesth Analg. 1989; 68: 144-146
        • Lui P.W.
        • Lee T.Y.
        • Chan S.H.H
        Involvement of locus coeruleus and noradrenergic neurotransmission in fentanyl-induced muscular rigidity in the rat.
        Neurosci Lett. 1989; 96: 114-119
        • Lusk J.A.
        • Maloley P.A.
        Morphine-induced pulmonary edema.
        Am J Med. 1988; 84: 367-368
        • MacDonald F.C.
        • Gough K.J.
        • Nicoll R.A.G
        • et al.
        Psychomotor effects of ketorolac in comparison with buprenorphine and diclofenac.
        Br J Clin Pharmacol. 1989; 27: 453-459
        • Mahla M.E.
        • White S.E.
        • Moneta M.D.
        Delayed respiratory depression after alfentanil.
        Anesthesiology. 1988; 69: 593-595
        • Marshall H
        • Porteous C
        • McMillan I
        • et al.
        Relief of pain by infusion of morphine after operation: Does tolerance develop?.
        Br Med J. 1985; 291: 19-21
        • Martin W.R.
        Pharmacology of opioids.
        Pharmacol Rev. 1983; 35: 283-323
        • McCaffery M
        • Beebe A
        Managing your patients’ adverse reactions to narcotics.
        Nursing. 1989; 19: 166-168
        • McDonald C.F.
        • Thomson S.A.
        • Scott N.C.
        • et al.
        Benzodiazepine-opiate antagonism—a problem in intensive-care therapy.
        Intensive Care Med. 1986; 12: 39-42
        • Mirenda J
        • Tabatabai M
        • Wong K
        Delayed and prolonged rigidity greater than 24 h following high-dose fentanyl anesthesia.
        Anesthesiology. 1988; 69: 624-625
        • Miser A.W.
        • Chayt K.J.
        • Sandlund J.T.
        • et al.
        Narcotic withdrawal syndrome in young adults after the therapeutic use of opiates.
        Am J Dis Child. 1986; 140: 603-604
        • Mojaverian P
        • Fedder I.L.
        • Vlasses P.H.
        • et al.
        Cimetidine does not alter morphine disposition in man.
        Br J Clin Pharmacol. 1982; 14: 809-813
        • Murray A.W.
        • Brockway M.S.
        • Kenny G.N.C
        Comparison of the cardiorespiratory effects of ketorolac and alfentanil during propofol anaesthesia.
        Br J Anaesth. 1989; 63: 601-603
        • Neidhart P
        • Burgener M.C.
        • Schwieger I
        • et al.
        Chest wall rigidity during fentanyl-and midazolam-fentanyl induction: Ventilatory and haemodynamic effects.
        Acta Anaesthesiol Scand. 1989; 33: 1-5
        • Nishino K
        • Su Y.F.
        • Wong C.S.
        • et al.
        Dissociation of µ opioid tolerance from receptor down-regulation in rat spinal cord.
        J Pharmacol Exp Ther. 1990; 253: 67-72
        • Owen H
        • Reekie R.M.
        • Clements J.A.
        • et al.
        Analgesia from morphine and ketamine: A comparison of infusions of morphine and ketamine for postoperative analgesia.
        Anaesthesia. 1987; 42: 1051-1056
        • Park G.R.
        • Gray P.A.
        Infusions of analgesics, sedatives and muscle relaxants in patients who require intensive care.
        Anaesthesia. 1989; 44: 879-880
        • Park G.R.
        • Manara A.R.
        • Mendel L
        • et al.
        Ketamine infusion: Its use as a sedative, inotrope and bronchodilator in a critically ill patient.
        Anaesthesia. 1987; 42: 980-983
        • Parkinson S.K.
        • Bailey S.L.
        • Little W.L.
        • et al.
        Myoclonic seizure activity with chronic high-dose spinal opioid administration.
        Anesthesiology. 1990; 72: 743-745
        • Pasternak G.W.
        Multiple morphine and enkephalin receptors and the relief of pain.
        JAMA. 1988; 259: 1362-1367
        • Pauga A.L.
        • Savage R.T.
        • Simpson S
        • et al.
        Effect of pethidine, fentanyl and morphine on post-operative shivering in man.
        Acta Anaesthesiol Scand. 1984; 28: 138-143
        • Powell H
        • Smallman J.M.B
        • Morgan M
        Comparison of intramuscular ketorolac and —morphine in pain control after laparotomy.
        Anaesthesia. 1990; 45: 538-542
        • Rao T.L.K
        • Mummaneni N
        • El-Etr A.A.
        Convulsions: An unusual response to intravenous fentanyl administration.
        Anesth Analg. 1982; 61: 1020-1021
        • Rawal N
        • Arner S
        • Gustafsson L.L.
        • et al.
        Present state of extradural and intrathecal opioid analgesia in Sweden.
        Br J Anaesth. 1987; 59: 791-799
        • Reimann I.W.
        • Frolich J.C.
        Effects of diclofenac on lithium kinetics.
        Clin Pharmacol Ther. 1981; 30: 348-352
        • Rivard J.C.
        • Lebowitz P.W.
        Bradycardia after alfentanil-succinylcholine.
        Anesth Analg. 1988; 67: 907
        • Rosow C.E.
        • Philbin D.M.
        • Keegan C.R.
        • et al.
        Hemodynamics and histamine release during induction with sufentanil or fentanyl.
        Anesthesiology. 1984; 60: 489-491
        • Rowbotham D.J.
        • Bamber P.A.
        • Nimmo W.S.
        Comparison of the effect of cisapride and metoclopromide on morphine-induced delay in gastric emptying.
        Br J Clin Pharmacol. 1988; 26: 741-746
        • Rucquoi M
        • Camu F
        Cardiovascular responses to large doses of alfentanil and fentanyl.
        Br J Anaesth. 1983; 55: 223S-230S
        • Scamman F.L.
        • Ghoneim M.M.
        • Korttila K
        Ventilatory and mental effects of alfentanil and fentanyl.
        Acta Anaesthesiol Scand. 1984; 28: 63-67
        • Scott J.C.
        • Sarnquist F.H.
        Seizure-like movements during a fentanyl infusion with absence of seizure activity in a simultaneous EEG recording.
        Anesthesiology. 1985; 62: 812-814
        • Scott P.V.
        • Fischer H.B.J
        Spinal opiate analgesia and facial pruritus: A neural theory.
        Postgrad Med J. 1982; 58: 531-535
        • Sebel P.S.
        • Bovill J.G.
        Fentanyl and convulsions.
        Anesth Analg. 1983; 62: 855-862
        • Shafer A
        • White P.F.
        • Schuttler J
        • et al.
        Use of a fentanyl infusion in the intensive care unit: Tolerance to its anesthetic effects?.
        Anesthesiology. 1983; 59: 245-248
        • Sherman E.P.
        • Lebowitz P.W.
        • Street W.C.
        Bradycardia following sufentanil-succinylcholine.
        Anesthesiology. 1987; 66: 106
        • Shetty G.K.
        • Kelsall P.G.
        • Ryan D.W.
        Long-term ketamine infusion.
        Anaesthesia. 1986; 41: 1262-1263
        • Silbert B.S.
        • Rosow C.E.
        • Keegan C.R.
        • et al.
        The effect of diazepam on induction of anesthesia with alfentanil.
        Anesth Analg. 1986; 65: 71-77
        • Silbert B.S.
        • Vacanti C.A.
        Amantidine in prevention of fentanyl-induced muscle rigidity.
        Anesth Analg. 1987; 66: 1338
        • Sinclair M.E.
        • Sear J.W.
        • Summerfield R.J.
        • et al.
        Alfentanil infusions on the intensive therapy unit.
        Intensive Care Med. 1988; 14: 55-59
        • Smith N.T.
        • Benthuysen J.L.
        • Bickford R.G.
        • et al.
        Seizures during opioid anesthetic induction—are they opioid-induced rigidity?.
        Anesthesiology. 1989; 71: 852-862
        • Spiess B.D.
        • Sathoff R.H.
        • El-Ganzouri A.R.S
        • et al.
        High-dose sufentanil: Four cases of sudden hypotension on induction.
        Anesth Analg. 1986; 65: 703-705
        • Stallard S
        • Prescott S
        Postoperative urinary retention in general surgical patients.
        Br J Surg. 1988; 75: 1141-1143
        • Stambaugh J.E.
        • Wainer I.W.
        Drug interaction: Meperidine and chlorpromazine, a toxic combination.
        J Clin Pharmacol. 1981; 21: 140-146
        • Stambaugh J.E.
        • Wainer I.W.
        • Schwartz I
        The effect of phenobarbital on the metabolism of meperidine in normal volunteers.
        J Clin Pharmacol. 1978; 18: 482-490
        • Staritz M
        • Poralla T
        • Manns M
        • et al.
        Effect of modern analgesic drugs (tramadol, pentazocine, and buprenorphine) on the bile duct sphincter in man.
        Gut. 1986; 27: 567-569
        • Starr N.J.
        • Sethna D.H.
        • Estafanous F.G.
        Bradycardia and asystole following the rapid administration of sufentanil and vecuronium.
        Anesthesiology. 1986; 64: 521-523
        • Stenseth R
        • Sellevold O
        • Breivik H
        Epidural morphine for postoperative pain: Experience with 1085 patients.
        Acta Anaesthesiol Scand. 1985; 29: 148-156
        • Stillman M.T.
        • Schlesinger P.A.
        Nonsteroidal anti-inflammatory drug nephrotoxicity: Should we be concerned?.
        Arch Intern Med. 1990; 150: 268-270
        • Stoeckel H
        • Hengstmann J.H.
        • Schuttler J
        Pharmacokinetics of fentanyl as a possible explanation for recurrence of respiratory depression.
        Br J Anaesth. 1979; 51: 741-745
        • Strong W.E.
        • Matson M
        Probable seizure after alfentanil.
        Anesth Analg. 1989; 68: 692-693
        • Tenebein M
        Continuous naloxone infusion for opiate poisoning in infancy.
        J Pediatr. 1984; 105: 645-648
        • Toft P
        • Helbo-Hansen S
        Interaction of ketamine with atracurium.
        Br J Anaesth. 1989; 62: 319-320
        • Tong T.G.
        • Pond S.M.
        • Kreek M.J.
        • et al.
        Phenytoin-induced methadone withdrawal.
        Ann Intern Med. 1981; 94: 349-351
        • Tubaro E
        • Borelli G
        • Croce C
        • et al.
        Effect of morphine on resistance to infection.
        J Infect Dis. 1983; 148: 656-666
        • Tverskoy M
        • Fleyshman G
        • Ezry J
        • et al.
        Midazolam-morphine sedative interaction in patients.
        Anesth Analg. 1989; 68: 282-285
        • Vercauteren M
        • Lauwers E
        • Meert T
        • et al.
        Comparison of epidural sufentanil plus clonidine with sufentanil alone for postoperative pain relief.
        Anaesthesia. 1990; 45: 531-534
        • Vinik H.R.
        • Bradley E.L.
        • Kissin I
        Midazolam-alfentanil synergism for anesthetic induction in patients.
        Anesth Analg. 1989; 69: 213-217
        • Webster J
        Interactions of NSAIDs with diuretics and (3-blockers: Mechanisms and clinical implications.
        Drugs. 1985; 30: 32-41
        • Weinger M.B.
        • Cline E.J.
        • Smith N.T.
        • et al.
        Ketanserin pretreatment reverses alfentanil-induced muscle rigidity.
        Anesthesiology. 1987; 67: 348-354
        • Weinger M.B.
        • Cline E.J.
        • Smith N.T.
        • et al.
        Localization of brainstem sites which mediate alfentanil-induced muscle rigidity in the rat.
        Pharmacol Biochem Behav. 1988; 29: 573-580
        • Weinger M.B.
        • Segal I.S.
        • Maze M
        Dexmedetomidine, acting through central α2-adrenoceptors, prevents opiate-induced muscle rigidity in the rat.
        Anesthesiology. 1989; 71: 242249
        • West J.M.
        • Estrada S
        • Heerdt M
        Sudden hypotension associated with midazolam and sufentanil.
        Anesth Analg. 1987; 66: 693-694
        • White P.F.
        Mishaps with patient-controlled analgesia.
        Anesthesiology. 1987; 66: 81-83
        • White P.F.
        • Coe V
        • Shafer A
        • et al.
        Comparison of alfentanil with fentanyl for outpatient anesthesia.
        Anesthesiology. 1986; 64: 99-106
        • Wiggum D.C.
        • Cork R.C.
        • Weldon S.T.
        • et al.
        Postoperative respiratory depression and elevated sufentanil levels in a patient with chronic renal failure.
        Anesthesiology. 1985; 63: 708-710
        • Wootton J.R.
        Postoperative pain relief; a new approach: Narcotics compared with nonsteroidal anti-inflammatory drugs [letter].
        Ann R Coll Surg Engl. 1990; 72: 66
        • Yee J.P.
        • Koshiver J.E.
        • Allbon C
        • et al.
        Comparison of intramuscular ketorolac tromethamine and morphine sulfate for analgesia of pain after major surgery.
        Pharmacotherapy. 1986; 6: 253-261
        • Zarfin Y
        • Koren G
        • Maresky D
        • et al.
        Possible indomethacin-aminoglycoside interaction in preterm infants.
        J Pediatr. 1985; 106: 511-513
        • Zucker-Pinchoff B
        • Ramanathan S
        Anaphylactic reaction to epidural fentanyl.
        Anesthesiology. 1989; 71: 599-601