Switching from High-dose Fentanyl to Low-doseMorphine Induced Relief of Dyspnea in a Patient with COVID-19 Pneumonia under Mechanical Ventilation: A Case Report

DOI Web Site Research Data 14 References Open Access
  • Ihara Naho
    Palliative Care Center, Keio University School of Medicine Department of Anesthesiology, Keio University School of Medicine
  • Takino Yoko
    Palliative Care Center, Keio University School of Medicine
  • Ohgishi Miwako
    Palliative Care Center, Keio University School of Medicine
  • Takeuchi Mari
    Palliative Care Center, Keio University School of Medicine Department of Neuropsychiatry, Keio University School of Medicine
  • Abe Akiko
    Palliative Care Center, Keio University School of Medicine Department of Neuropsychiatry, Keio University School of Medicine
  • Kaneko Ken
    Department of Hospital Pharmacy, Keio University Hospital
  • Sakurai Hiroomi
    Department of Hospital Pharmacy, Keio University Hospital
  • Fujita Sachiko
    Division of Clinical Region, Keio University Hospital
  • Nagata Hiromasa
    Department of Anesthesiology, Keio University School of Medicine
  • Hashiguchi Saori
    Department of Palliative Medicine, St.Marianna University, School of Medicine
  • Morisaki Hiroshi
    Department of Anesthesiology, Keio University School of Medicine

Bibliographic Information

Other Title
  • 人工呼吸管理下にあるCOVID-19肺炎の呼吸困難に高用量静注フェンタニルから低用量静注モルヒネ投与へのスイッチングが有効であった1症例

Search this article

Description

<p>Introduction: The efficacy of fentanyl to relieve dyspnea in comparison to morphine remains to be determined. We report a case in which switching from high-dose intravenous fentanyl to low-dose intravenous morphine relieved dyspnea in a patient with COVID-19 pneumonia. Case: An 85-year-old man who was intubated and mechanically ventilated due to severe COVID-19 pneumonia, received continuous intravenous fentanyl for pain relief. Despite several modulations of the ventilation mode, he showed persistent dyspnea under mechanical ventilation. To relieve his dyspnea, the fentanyl dose was increased to 2,400 μg per day; however, this was ineffective. Our palliative care team intervened and switched the patient’s opioid to 76.8 mg per day of morphine, which was less than the equal conversion based on cancer pain conversion. After this switch, his apparent dyspnea was alleviated, but his respiratory rate decreased. The dose of morphine was gradually reduced to 10 mg per day to alleviate respiratory depression. Discussion: In this case, switching to morphine at doses much lower than the intravenous dose of fentanyl could induce relief of dyspnea. Morphine may be more effective than fentanyl for dyspnea due to COVID-19.</p>

Journal

References(14)*help

See more

Keywords

Details 詳細情報について

Report a problem

Back to top