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Am J Emerg Med. 2018 Nov;36(11):2044-2049. doi: 10.1016/j.ajem.2018.03.026. Epub 2018 Mar 14.

Association of fentanyl use in rapid sequence intubation with post-intubation hypotension.

Author information

1
Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan. Electronic address: jint@jadecom.jp.
2
Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street Boston, Suite 920, Boston, MA 02114, USA.
3
Center for Clinical Epidemiology, St. Luke's International University, 3-6 Tsukiji, Chuo, Tokyo 104-0045, Japan.
4
Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561, Japan.
5
Department of Radiology, University of Washington, 850 Republican Street Seattle, WA 98006, USA.
6
Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan; Department of Emergency Medicine, International University of Health and Welfare, 1-4-3 Mita, Minato, Tokyo 108-8329, Japan.
7
Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street Boston, Suite 920, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.

Abstract

BACKGROUND:

The anesthesia literature has reported that pre-intubation fentanyl use is associated with post-intubation hypotension which is a risk factor of poor post-emergency department (ED) prognosis. However, little is known about the relations between fentanyl use for intubation and post-intubation hypotension in the ED. We aimed to determine whether pretreatment with fentanyl was associated with a higher risk of post-intubation hypotension in the ED.

METHODS:

We conducted a secondary analysis of data of ED airway management collected from a multicenter prospective study of 14 Japanese EDs from February 2012 through November 2016. We included all adult non-cardiac-arrest patients who underwent rapid sequence intubation for medical indication. Patients were divided into fentanyl and non-fentanyl groups. The primary outcome was post-intubation hypotension (systolic blood pressure ≤90mmHg) in the ED.

RESULTS:

Of 1263 eligible patients, 466 (37%) patients underwent pretreatment with fentanyl. The fentanyl group had a higher risk of post-intubation hypotension (17% vs. 6%; unadjusted OR, 1.73; 95%CI, 1.01-2.97; P=0.048) compared to the non-fentanyl group. In the multivariable analysis adjusting for age, sex, weight, principal indication, sedatives, intubator's specialty, number of intubation attempts, and patient clustering within EDs, the fentanyl group had a higher risk of post-intubation hypotension (adjusted OR, 1.87; 95%CI, 1.05-3.34; P=0.03) compared to the non-fentanyl group. In the sensitivity analysis using propensity score matching, this association remained significant (OR, 3.17; 95%CI, 1.96-5.14; P<0.01).

CONCLUSION:

In this prospective multicenter study of ED airway management, pretreatment with fentanyl in rapid sequence intubation was associated with higher risks of post-intubation hypotension.

KEYWORDS:

Adverse events; Emergency department; Fentanyl; Post-intubation hypotension; Rapid sequence intubation

PMID:
29653790
DOI:
10.1016/j.ajem.2018.03.026
[Indexed for MEDLINE]

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