Interesting NAEMSP Abstracts

[Guest guest]

Are Changes in Physiological Parameters After Fentanyl Dosing Predictable?

Sachita Shah, Krauss, , Massachusetts General

Hospital, Boston, Massachusetts

Objectives: Given concerns about hypotension, hypoxia, and decline in mental

status following EMS Fentanyl use, this study was conducted to assess

whether vital sign abnormalities/GCS change was predictable based on patient

age, gender, initial vital signs, dose, or patient diagnosis. Methods: This

was a retrospective review of 100 consecutive scene and interfacility

helicopter EMS transports (7/06), where fentanyl analgesia was administered

by a nurse/paramedic crew operating under standing orders, including

fentanyl at 1-5 b.mug/kg. A total of 199 separate doses of Fentanyl in this

group were analyzed. A multivariate linear regression model with dependent

variable initial fentanyl dose (b.mug/kg) assessed the independent variables

of: age (the primary end point, group as pediatric age < 18, adult age

18-65, geriatric age > 65), sex, initial vital signs, GCS, and intubation

status. The overall (entire transport period) fentanyl dose was also

assessed ascertain whether any adverse events were associated with larger

total Fentanyl doses. Statistical methods also included descriptive

techniques (medians, 95% confidence intervals CI), b.chi2 testing for

categorical variables, and Kruskal-Wallis testing for nonparametric

continuous variables. Statistical significance was defined at the p = 0.05

level. Results: Percentage blood pressure drop was not predictable based on

gender, (p > 0.289)), age (p > 0.541), dose per kilogram (p > 0.945),

intubation status (p > 0.918), initial systolic blood pressure (p > 0.07),

or patient diagnosis (cardiac, medical/surgical, trauma, neurological). No

clinically significant drop in SPO2 or GCS occurred in any non-intubated

patients. Conclusions: (1) This study fails to confirm that factors

sometimes mentioned as predisposing patients to fentanyl-associated vital

signs depression such as age, gender, dose/kg, or initial vital signs would

predict vital signs depression or GCS decline after fentanyl dosing. (2) No

differences were found in vital signs parameters after Fentanyl between

cardiac, medical/surgical, trauma, and neurological patient groups.