[Rapid release fentanyl administration forms. Comments of the Working Group on Tumor Pain of the German Pain Society]. / Schnell freisetzende Fentanylapplikationsformen. Stellungnahme des Arbeitskreises Tumorschmerz der Deutschen Schmerzgesellschaft.

The spectrum of indications for rapid release fentanyl preparations is controversial. For this reason the Working Group on Tumor Pain will formulate comments on how to deal with these substances. Breakthrough pain should receive individualized therapy; therefore, the use of opioids of various galenic formulations seems to be advisable. New rapid release fentanyl preparations are suitable for alleviating spontaneous breakthrough pain in tumor patients due to a rapid but short-acting effect. However, a prior optimization of the analgesic basis medication is absolutely necessary. Uncontrolled prescription for non-cancer pain must be criticized due to the problem of addiction. The medical profession should be informed about the benefits of rapid release fentanyl preparations but must also be made aware of the risk of a rapid development of addiction and tolerance. A self-commitment of the pharmaceutical industry to waive advertising for the dangerous off-label use would be desirable. In the opinion of the Working Group on Tumor Pain the use of fentanyl should be openly discussed and further scientific investigations are imperative with the aim of formulating clear recommendations.

[Significant CO2 retention in children after premedication with Dormicum and Thalamonal]. / Bedenkliche CO2-Retention bei Kindern nach Prämedikation mit Dormicum und Thalamonal.

Whereas in adults the use of Innovar for premedication has been abolished, the combination of midazolam and Innovar is still recommended for the premedication of children. This combination may lead to an additional depressive effect on respiration. A prospective, randomized study was performed to evaluate the risk of ventilatory depression. In 36 infants capillary blood gas values were measured pre- and postmedication with either rectal midazolam (0.4 mg/kg) and i.m. Innovar (0.04 ml/kg) or after oral chlorprothixene (2.0 mg/kg). After chlorprothixen the blood gas values did not change, whereas after the combination of midazolam and Innovar pCO2 rose significantly from 35.5 to 43.0 mmHg. In 7 of 22 cases pCO2 reached values above 45 mmHg. This difference compared to the chlorprothixene group was significant (p less than 0.05). The pH fell significantly from 7.42 to 7.36 in the combination group. Clinical signs of respiratory depression could not be observed in this group. The combination of midazolam with Innovar is therefore not useful for premedication in infants and young children.