DOI: https://doi.org/10.14710/jai.v12i3.32872

Penggunaan Fentanyl pada Pasien Sakit Kritis COVID-19

Departemen Anestesiologi Terapi Intensif dan Manajemen Nyeri, Fakultas Kedokteran, Universitas Hasanuddin, Makassar, Indonesia

Published: 1 Nov 2020.

Citation Format:
Abstract

Latar Belakang: Nyeri merupakan salah satu masalah utama pada pasien yang dirawat di unit perawatan intensif (ICU). Kombinasi antara pressor response akibat nyeri dengan gangguan oksigenasi pada Corona Virus Disease 2019 (COVID-19) dapat berdampak negatif pada pasien, sehingga menghambat pemulihannya. Opioid sering digunakan untuk mengatasi nyeri di ICU. Namun, efek sampingnya, terutama efek imunosupresif pada pasien COVID-19 masih belum jelas. Opioid dianggap berpotensi memperburuk infeksi COVID-19 dan dapat menyebabkan efek depresi pernapasan pada pasien COVID-19 yang sakit kritis, namun masih kontroversial.

Kasus: Wanita, 53 tahun dirawat di unit perawatan intensif dengan pneumonia bilateral yang terkonfirmasi COVID-19. Pasien diberikan fentanyl intravena secara kontinyu sebagai analgesia selama perawatan bantuan pernapasan dengan intubasi endotrakeal dan ventilator mekanis. Pasien menerima opioid fentanyl selama lebih dari seminggu sampai lepas dari ventilasi mekanis dan kemudian diekstubasi. Setelah ekstubasi, pasien mendapat terapi oksigen dengan high flow nasal cannula (HFNC) hingga tidak membutuhkan suplemen oksigen. Pasien keluar dari unit perawatan intensif setelah 14 hari perawatan.

Pembahasan: Dengan menggunakan analgesia opioid fentanyl pada pasien ini, analgesia yang baik dapat tercapai. Penilaian analgesia selama ventilasi mekanis menggunakan behaviour pain scale dan terlihat respons yang baik pada pasien ini. Pasien tidak mengalami infeksi yang semakin parah seperti yang ditakutkan dengan penggunaan opioid pada pasien kritis, namun kemungkinan peran imunosupresif dari opioid masih perlu ditelusuri lebih lanjut.

Kesimpulan: Penggunaan opioid fentanyl dapat memberikan analgesia yang baik pada pasien COVID-19 yang sakit kritis dengan luaran pasien yang baik.

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
CTA
Subject
Type Other
  Download (B)    Indexing metadata
 common.other
CTA
Subject
Type Other
  Download (622KB)    Indexing metadata
Keywords: analgesia; COVID-19; opioid; pasien kritis; sistem imun

Article Metrics:

Article Info
Section: Case Reports
Language : ID
Recent articles
Penggunaan Fentanyl pada Pasien Sakit Kritis COVID-19 Penggunaan Heparin Dosis Tinggi pada Pasien COVID-19 dengan ARDS dan Hipertensi di Unit Perawatan Intensif (ICU) Tatalaksana Komplikasi Tromboemboli pada Pasien Terkonfirmasi Corona Virus Disease-19 More recent articles
Most cited articles
Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida Patofisiologi Penyakit Jantung Koroner More cited articles
  1. Altinbas A et al. Pain Management in Critical Patient. Arch Clin Biomed Res. 2016;1(5):242–9
  2. Mehta P et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–4
  3. Bruder N et al. Consequences and Prevention Methods of Hemodynamic Changes During Laryngoscopy and Intratracheal Intubation. Ann Fr Anesth Reanim. 1992;11(1):57–71
  4. Nooh N et al. Effect of remifentanil on the hemodynamic responses and recovery profile of patients undergoing single jaw orthognathic surgery. Int J Oral Maxillofac Surg. 2013;42(8):988–93
  5. Adam VN et al. Pain management in critically ill patients. Period Biol. 2015;117(2):225–30
  6. Pouraghaei M et al. Comparison between the effects of alfentanil, fentanyl and sufentanil on hemodynamic indices during rapid sequence intubation in the emergency department. Anesthesiol Pain Med. 2014;4(1):1–6
  7. Pournajafian A et al. Comparison of remifentanil and fentanyl regarding hemodynamic changes due to endotracheal intubation in preeclamptic parturient candidate for cesarean delivery. Anesthesiol Pain Med. 2012;2(2):90–3
  8. Mireskandari SM et al. Comparison of the effect of fentanyl, sufentanil, alfentanil and remifentanil on cardiovascular response to tracheal intubation in children. Iran J Pediatr. 2011;21(2):173–80
  9. Lambert D. Opioids and the COVID-19 pandemic: does chronic opioid use or misuse increase clinical vulnerability? Br J Anaesth [Internet]. 2020; Available from: https://doi.org/10.1016/j.bja.2020.07.004
  10. Al-Hashimi M et al. Opioids and immune modulation: More questions than answers. Br J Anaesth. 2013;111(1):80–8. Available from: http://dx.doi.org/10.1093/bja/aet153
  11. Cohen SP et al. Pain Management Best Practices from Multispecialty Organizations during the COVID-19 Pandemic and Public Health Crises. Pain Med. 2020
  12. Schimmel J et al. Opioid Use Disorder and COVID-19: Biological Plausibility for Worsened Outcomes. Subst Use Misuse [Internet]. 2020;55(11):1–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32657207
  13. Shang Y et al. Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China. Ann Intensive Care. 2020;10(1):1–24
  14. McGrane S et al. Sedation in the intensive care unit. Minerva Anestesiol. 2012;78(3):369–80
  15. Mahler DA. Opioids for refractory dyspnea. Expert Rev Respir Med. 2013;7(2):123–35
  16. Niesters M et al. High-inspired oxygen concentration further impairs opioid-induced respiratory depression. Br J Anaesth [Internet]. 2013;110(5):837–41. Available from: http://dx.doi.org/10.1093/bja/aes494
  17. Moyano J et al. Opioids in the immune system: From experimental studies to clinical practice. Rev Assoc Med Bras. 2019;65(2):262–9
  18. Devabhakthuni S et al. Analgosedation: A Paradigm Shift in Intensive Care Unit Sedation Practice. Ann Pharmacother. 2012;46(4):530–40
  19. Pattinson KTS. Opioids and the control of respiration. Br J Anaesth [Internet]. 2008;100(6):747–58. Available from: http://dx.doi.org/10.1093/bja/aen094
  20. Hemmings HC et al. The good, the bad, and the ugly: the many faces of opioids. Br J Anaesth. 2019;122(6):705–7
  21. Weil J V. et al. Diminished Ventilatory Response to Hypoxia and Hypercapnia After Morphine in Normal Man. N Engl J Med. 1975;1103–6
  22. Clemens KE et al. Symptomatic Therapy of Dyspnea with Strong Opioids and Its Effect on Ventilation in Palliative Care Patients. J Pain Symptom Manage. 2007;33(4):473–81
  23. Drożdżal S et al. COVID-19: Pain management in patients with SARS-CoV-2 infection—molecular mechanisms, challenges, and perspectives. Brain Sci. 2020;10(7):1–10
  24. Eisenstein TK. The Role of Opioid Receptors in Immune System Function. Front Immunol. 2019;10(December):1–20
  25. Plein LM et al. Opioids and the immune system – friend or foe. Br J Pharmacol. 2018;175(14):2717–25
  26. Mefford BM et al. Opioids and the immune system. US Pharm. 2020;45(3):HS-10
  27. Franchi S et al. Do All Opioid Drugs Share the Same Immunomodulatory Properties? A Review From Animal and Human Studies. Front Immunol. 2019;10:1–11
  28. Azmi NU et al. Cytokine Storm in COVID-19: An Overview, Mechanism, Treatment Strategies, and Stem Cell Therapy Perspective. Pharm Sci Res. 2020;7(4):1–11
  29. Zeng Q et al. Mortality of COVID-19 is Associated with Cellular Immune Function Compared to Immune Function in Chinese Han Population Qiang. medRxiv. 2020;1–15
  30. Lopez B et al. Anesthetics. In: Lippincott® Illustrated Reviews: Pharmacology. 7th ed. China: Wolters Kluwer; 2019
  31. Ammar MA et al. Sedation, Analgesia, and Paralysis in COVID-19 Patients in the Setting of Drug Shortages. J Intensive Care Med. 2020

Last update:

No citation recorded.

Last update: 2024-04-19 08:52:20

No citation recorded.