Continuous Infusion Of Fentanyl Research Articles

Continuous fentanyl infusion reduces intra-abdominal pressure, postoperative pain and normalizes lungs’ mechanical changes in newborn with viscera-abdominal disproportion in early post-operative period

We aimed to study the influence of prolonged administration of fentanyl on postoperative pain, intra­ab­dominal pressure and mechanical lungs’ changes that may happen in neonates in early post­operative period. 30 newborns (in the period from January 2017 to May 2021) with gastroschisis were divided into two groups ac­cordingly to the method of analgesia (14 – morphine hydrochloride; 16 – prolonged infusion of fentanyl). Lungs’ mechanical characteristics, effectiveness of post­operative analgesia, abdominal wall relaxation was studied by monitoring of dynamic compliance (Cdyn), pressure and flow­volume loops, capnography. Apprising analgesia sta­tus, we measured hemodynamic, SаO2, blood level of cortizol, C­reactive protein (CRP), glucose, analyzed post­operative pain syndrome using visual analogue scales (VAS). Intra­abdominal pressure (IAP) was controlled by Cron. For statistic analysis we used Student’s t­test. In the group with morphine, thete was the increase of IAP by 11–12 cm H2O, being stable during some period of time, and also variable levels of pain according to VAS, the in­creasing of CRP from 0.8 ± 0.25 mg/dl by 5 mg/dl, cortisol by 674.4 nmol/l, and blood glucosae rate – 7.4 mmol/l. Periods with high traumatic effects and poor analgesia (morphine group) reasoned the increasing IAP, step by step dynamic compliance decreasing in 3.4 times, resistance increasing in 2.42 times and PIP rising till 22 cm H2O. Di­rect correlation between IAP increase and lungs’ mechanical changes took place. The study has demonstrated that prolonged administration of fentanyl prevented high increase of IAP, CRP, levels of glucose and cortizol and changes of VAS data, lungs’ mechanical characteristics.

Analgosedation: The Use of Fentanyl Compared to Hydromorphone.

BackgroundThe 2018 Society of Critical Care Medicine guidelines on the “Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU” advocate for protocol-based analgosedation practices. There are limited data available to guide which analgesic to use. This study compares outcomes in patients who received continuous infusions of fentanyl or hydromorphone as sedative agents in the intensive care setting.MethodsThis retrospective cohort study evaluated patients admitted into the medical intensive care unit, the surgical intensive care unit, and the cardiac intensive care unit from April 1, 2017, to August 1, 2018, who were placed on continuous analgesics. Patients were divided according to receipt of fentanyl or hydromorphone as a continuous infusion as a sedative agent. The primary endpoints were ICU length of stay and time on mechanical ventilation.ResultsA total of 177 patients were included in the study; 103 received fentanyl as a continuous infusion, and 74 received hydromorphone as a continuous infusion. Baseline characteristics were similar between groups. Patients in the hydromorphone group had deeper sedation targets. Median ICU length of stay was eight days in the fentanyl group compared to seven days in the hydromorphone group (p = 0.11) and median time on mechanical ventilation was 146.47 hours in the fentanyl group and 122.33 hours in the hydromorphone group (p = 0.31). There were no statistically significant differences in the primary endpoints of ICU length of stay and time on mechanical ventilation between fentanyl and hydromorphone for analgosedation purposes.ConclusionNo statistically significant differences were found in the primary endpoints studied. Patients in the hydromorphone group required more tracheostomies, restraints, and were more likely to have a higher proportion of Critical Care Pain Observation Tool (CPOT) scores > 2.

Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients.

Opioids are a mainstay of therapy for patients in the intensive care unit (ICU) as part of the analgesia-first approach to sedation. Despite knowledge of acute consequences of opioid based analgosedation, less is known about the potential long-term consequences, including the effect of opioid administration in the ICU on subsequent opioid use in opioid-naïve patients. To evaluate the relationship between ICU opioid administration to opioid-naïve patients and subsequent opioid use following discharge. A query of the electronic medical record was performed to identify opioid-naïve adult patients admitted directly to an ICU. Patients who received continuous intravenous infusion of fentanyl, hydromorphone, or morphine were screened for inclusion into the analysis. Of the 342 patients included for analysis, 164 (47.1%) received an opioid at hospital discharge. In total, 17 of the 342 patients (5.0%) became long-term users, noted to be more common in patients who received an opioid prescription at discharge (8.7% vs 1.6%; P = 0.006). Neither total ICU morphine milligram equivalent (MME) nor average daily ICU MME administration were found to correlate with daily MME prescription quantity at discharge (R2 = 0.008 and R2 = 0.03, respectively). Following control for potentially confounding variables, total ICU MME administration remained an insignificant predictor of subsequent receipt of an opioid prescription at discharge and long-term opioid use. This study failed to find a significant relationship between ICU opioid use in opioid-naïve patients and subsequent opioid use. These findings highlight the need to focus on transitions points between the ICU and discharge as potential opportunities to reduce inappropriate opioid continuation.

Rationale for analgesia to prevent postoperative hyperalgesia in children, according to the morphological study of skin in the wound

In the article, morphological changes of skin in the area of postoperative wound are displayed. It was discovered that continuous infusion of high-dose fentanyl (10–20 mcg/kg/h) for analgesia in the early postoperative period in children operated on for tumors of abdominal cavity can result into opiod-induced hyperalgesia, which is followed by skin morphological changes around the postoperative wound with the development of necrosis in it center with expressed perifocal reactive changes in the form of severe inflammation, and significant violations of microcirculation with the formation of small nerve fibers on day 14. In its turn, using TAP-block and combined spinal-epidural analgesia showed small perineural edema. The fragmentation of nerve fibers was not determined, which indicates the absence of development of postoperative hyperalgesia. Ketamine infusion results into negligible perineural edema and reduction of postoperative hyperalgesia.

Abnormal Ocular Examination Findings in a Term Infant.

A 3-hour-old full-term female neonate presents with white pupils noted at the time of NICU admission. ### Prenatal and Birth Histories The infant was limp and cyanotic at delivery and required positive pressure ventilation for 5 minutes. No risk factors for sepsis were noted and there was no evidence of placental abruption. In addition, the fetal heart rate tracing was normal before delivery. The reasons for the perinatal depression at birth were unclear. Subsequently, the infant started breathing spontaneously and was transitioned to room air. Neurologic examination findings obtained at the outside facility were significant for wide-eyed appearance with staring and generalized low muscle tone. ### Presentation The infant was transferred to the NICU at 3 hours of age for therapeutic hypothermia evaluation. Initial physical examination findings were remarkable for the presence of leukocoria bilaterally. This was visualized easily with both ambient lighting in the patient room as well as direct examination with an ophthalmoscope (Fig 1). Red reflex was absent bilaterally. Figure 1. Bilateral leukocoria. The infant’s neurologic assessment findings at admission were consistent with moderate hypoxic-ischemic encephalopathy. Therapeutic whole-body cooling was initiated. An umbilical venous catheter was placed and continuous electroencephalogram obtained. The infant also received ampicillin and ceftazidime, intravenous fluids, and continuous fentanyl infusion. ### Vital Signs (3 Hours of Age)

Continuous infusion of fentanil, dexmedetomidine or maropitant in dogs undergoing to ovariohysterectomia

The aim of this study was to compare the analgesic effects of continuous infusion of fentanyl, dexmedetomidine, or maropitant. The animals received pre-anesthetic medication and anesthetic induction. Subsequently, continuous infusion of drugs was instituted, distributed in the following groups: fentanyl, dexmedetomidine, and maropitant. During the surgical procedure, the analgesic effects were evaluated by recording the cardiorespiratory parameters at the moments of greatest pain stimulus. When evaluating analgesic effects, the maropitant group showed greater stability in cardiorespiratory parameters compared to the fentanyl and dexmedetomidine group. From this study, it is suggested that continuous infusion of maropitant has analgesic effects similar to fentanyl and greater than dexmedetomidine.

Influence of peri-incisional epaxial muscle infiltration with bupivacaine pre- or post-surgery on opioid administration in dogs undergoing thoraco-lumbar hemilaminectomy

This study investigated the influence of bupivacaine infiltration before or after hemilaminectomy on peri-operative opioid requirement in dogs. Thirty dogs undergoing T3-L3 hemilaminectomy were randomly assigned to receive peri-incisional infiltration of bupivacaine 2 mg/kg into the epaxial muscles before surgery (Group A), at wound closure (Group B), or no infiltration (Group C). Anaesthesia comprised dexmedetomidine 4 mcg/kg and methadone 0.3 mg/kg IV (premedication), alfaxalone IV (induction), and isoflurane in oxygen (maintenance). All dogs received meloxicam SC/PO prior to induction of general anaesthesia. Response to surgery, defined as a change in autonomic physiological variables >20% above baseline, was treated with fentanyl 2.5 mcg/kg boluses, followed by a continuous rate infusion of fentanyl at 5 mcg/kg/h. The Glasgow Composite Pain Score–Short Form (GCPS-SF) was performed before premedication and at regular intervals until 24 h postoperatively. Methadone 0.2 mg/kg analgesia was given IV if GCPS-SF was ≥5/20. Number of intraoperative, postoperative and total analgesic interventions were recorded. Analgesic interventions were analysed using a chi–squared test using a Pocock approach and statistical significance was set at P < 0.029.The number of intra-operative analgesic interventions in Group A (median, 0; range, 0–2), was significantly lower than in Group B (median, 3; range, 0–5) and Group C (median, 3; range, 0–5; P = 0.019). Regarding postoperative interventions, there were significantly fewer in Group A (median, 0; range, 0–1) and Group B (median, 0; range, 0–1) than in Group C (median, 1; range, 0–2; P = 0.047). Group A (median, 0; range, 0–3), had significantly fewer total analgesic interventions than Group B (median, 3; range, 0–6) and Group C (median, 4; range, 1–7; P = 0.014). Bupivacaine reduced peri-operative opioid administration and pre-surgical peri-incisional infiltration yielded the greatest benefit.

Avaliação das complicações transanestésicas comparando a infusão contínua peridural versus analgésica em cães submetidos a neurocirurgias

Neurosurgeries have become more frequent in veterinary hospitals, however, there are some questions regarding anesthetics protocols and analgesic techniques. Thus, patient analgesia and hemodynamic stability play a key role in pre, post, and perioperative moments favoring an adequate recovery. This study aimed to evaluate the transanesthetic complications reported on anesthetic records of dogs submitted to hemilaminectomies in the university veterinary hospital of the Federal University of Santa Maria (UFSM) between January 2016 and August 2017, and compare three different analgesic protocols most commonly used in the routine for this surgery. In addition, transanesthetic parameters for each dog were equally recorded in five-minute intervals: cardiac frequency (FC), respiratory frequency (f) blood oxygen saturation (SpO2), mean artery pressure (PAM), temperature and end tidal CO2 (EtCO2). The patients were divided into three groups: Group M: animals receiving epidural analgesia with morphine 0.1mg/kg diluted in 0.26 ml/kg of saline solution 0.9%; Group FLK: bolus of fentanyl 2 μg/kg, lidocaine 1 mg/kg, and ketamine 1 mg/kg followed by infusion of fentanyl 0.1 μg/kg/min, lidocaine 50 μg/kg/min and ketamine 10 μg/ kg/min; and Group F: bolus of fentanyl 2 μg/kg followed by infusion of fentanyl 0.1 μg/kg/min. ANOVA was used to evaluate the anesthetic protocols complications, followed by Tukey’s post-hoc test with a significance level of 5% (p 45mmHg). With this study, it was observed that the use of continuous infusions of FLK, fentanyl, and epidural analgesia with morphine, in the used doses, were effective and safe in the dogs submitted to neurosurgeries, however, it was noticed that the use of morphine caused a greater reduction in temperature during the intraoperative period.

1308: Impact of Ketamine Versus Fentanyl Continuous Infusion in a Surgical-Trauma Intensive Care Unit

Pazhani, Yogitha1; Roth, Jennifer2; Kataria, Vivek1; Ramos, Adrian3; Mooney, Jennifer4; Nguyen, Hoa5 Author Information

Intravenous Infusion of Fentanyl Has No Effect on Blood Concentration of Tacrolimus in Patients Receiving Hematopoietic Stem-Cell Transplantation.

Both tacrolimus (TAC) and fentanyl are frequently used in patients receiving allogeneic hematopoietic stem-cell transplantation. A recently published report demonstrated that fentanyl can reduce the total body clearance of TAC; however, most patients in this study were administered concomitantly with azole antifungal agents, which are known to be strong inhibitors of CYP3A. Hence, the exact effect of fentanyl on TAC pharmacokinetics was unclear. In the current study, the authors retrospectively investigated the pharmacokinetic interaction between TAC and fentanyl in patients who were not concomitantly administered drugs that affect TAC metabolism. Patients with continuous infusion of TAC and fentanyl after hematopoietic stem-cell transplantation at the Tokyo Medical and Dental University between January 2014 and December 2018 were enrolled. The total body clearance of TAC was compared before and after the initiation or discontinuation of fentanyl. Thirty patients (24 men and 6 women; median age, 11 years) were screened for their eligibility. Twenty-eight patients were enrolled for evaluating the effects of the fentanyl initiation on TAC pharmacokinetics; 2 patients were excluded because of the absence of data related to the TAC blood concentrations or the concomitant use of azole antifungals. Twenty patients were enrolled for investigating the effects of fentanyl discontinuation on TAC pharmacokinetics, whereas 10 patients were excluded because of the absence of data related to the blood concentration of TAC or the additional administration of azole antifungals. Furthermore, the total body clearance of TAC was not significantly affected by the initiation or discontinuation of fentanyl, although there were large interindividual variations. In addition, the results remained the same even when the analysis was performed independently for adults and children. Intravenous infusion of fentanyl does not affect the pharmacokinetics of TAC.

Preoperative retrograde reintubation during partial tracheal resection and anastomosis in a cat with severe tracheal stenosis

A seven-month-old European shorthair cat was presented with dyspnoea and expiratory stridor due to a severe obstructive tracheal stenosis. Surgical resection of the stenotic area and anastomosis of the remaining parts of the trachea were performed. The anaesthetic management of a patient during tracheal resection is an anaesthetic challenge. Total intravenous anaesthesia with propofol and a continuous rate infusion of fentanyl were chosen to maintain a surgical anaesthetic depth and to ensure pain control. Endotracheal extubation was necessary at a specific time during the surgical procedure. However, subsequent oral reintubation was complicated, due to patient positioning and the presence of laryngeal spasms. Reintubation was only successful by means of a modified retrograde intubation technique. Recovery was satisfactory and uneventful.

腰椎後方除圧術（1–2椎間）の術後鎮痛に対するフェンタニル持続静注の効果―後ろ向き研究

腰椎後方除圧術（1–2椎間）の術後鎮痛に対するフェンタニル持続静注の効果―後ろ向き研究

A case of successful anesthetic management in a patient with Trousseau\u2019s syndrome who underwent surgery for malignant ovarian tumor

BackgroundTrousseau’s syndrome, also known as cancer-associated thrombosis, has several perioperative considerations, including the timing of surgery, anticoagulant therapy, and anesthetic technique. While appropriate anesthetic management is critical, few clinical reports have addressed the issue. Here, we report a patient with Trousseau’s syndrome who successfully underwent gynecological surgery 1 month after a massive cerebral infarction.Case presentationA 46-year-old woman with malignant ovarian tumor and deep venous thrombosis developed systemic thromboembolism, including a massive right cerebral infarction, despite receiving direct oral anticoagulant therapy. She was diagnosed with Trousseau’s syndrome and was transferred to our hospital 17 days after the onset of cerebral infarction with left incomplete hemiparesis. Semi-radical gynecological surgery was scheduled in another 14 days (31 days after the cerebral infarction). A temporary inferior vena cava filter was placed, and both direct oral anticoagulant and antiplatelet drugs were substituted with unfractionated heparin infusion. She underwent surgery uneventfully under general anesthesia with desflurane and remifentanil. Postoperative analgesia was achieved with a peripheral nerve block and continuous intravenous infusion of fentanyl. The tumors were fully resected, thereby only anticoagulant therapy for residual venous thrombus was continued. She had a good perioperative course and was discharged without cerebral complications or thromboembolism.ConclusionsIn patients with Trousseau’s syndrome, both early radical surgery and preventing perioperative cerebrovascular complications are critical. In our present case, Trousseau’s syndrome was successfully operated under general anesthesia 1 month after a massive cerebral infarction.

Transversus abdominis plane block versus quadratus lumborum block type 2 for analgesia in renal transplantation: A randomised trial.

Several studies have shown an analgesic efficacy of a transversus abdominis plane block (TAPB) in reducing opioid requirements during and after cadaveric renal transplantation surgery, but the effect of a quadratus lumborum block (QLB) in this type of surgery is unclear. The main objective of this prospective, randomised, double-centre clinical study was to compare the analgesic efficacy of a one-sided lateral approach TAPB with a unilateral QLB type 2 in cadaveric renal transplantation surgery. Randomised, single-blinded trial. Two University-affiliated tertiary care hospitals between April 2016 and May 2017. A total of 101 patients aged more than 18 years, scheduled for cadaveric renal transplantation. On receiving ethical board approval and individual informed consent, consecutive patients were allocated randomly to receive either an ultrasound-guided single-shot lateral TAPB or an ultrasound-guided single-shot QLB type 2 on the surgical side using 20 ml of bupivacaine 0.25% with adrenaline after a standardised induction of general anaesthesia. All patients on surgical completion and recovery from general anaesthesia were admitted to the postanaesthesia care unit for 24 h. They received standardised intravenous patient-controlled analgesia with fentanyl, and their pain scores were noted at regular intervals. The primary endpoint was total cumulative fentanyl dose used per kg body mass in the first 24 h after surgery. Secondary outcomes were the need to start a continuous infusion of fentanyl in addition to patient-controlled analgesia boluses during the stay in post-anaesthesia care unit, postoperative pain severity measured using a numerical rating scale, patient satisfaction with analgesic treatment, evidence of postoperative nausea and vomiting, pruritus and sedation level. The 49 patients allocated to the QLB type 2 group used significantly less fentanyl per kg in the first 24 h after surgery than the 52 patients who received a TAPB (median [IQR] 4.2 [2.3 to 8.0] μg kg versus 6.7 [3.5 to 10.7] μg kg, P = 0.042). No statistically significant differences were noted in the secondary endpoints within the study, including the frequency of adverse effects of opioids. The reduction of fentanyl consumption in the first 24 h after renal transplantation with no difference in pain intensity and patient satisfaction shows a beneficial effect of one-sided QLB type 2 over a one-sided TAPB in regards to postoperative analgesia. However, the reduction in opioid consumption did not affect the frequency of opioid-related adverse effects. ClinicalTrials.gov ID: NCT02783586.

Fentanyl - Based Cardiac Anesthesia Provides Higher Recovery Compared with Morphine in Elective CABG Surgery Patients

Background : High-dose opioid anesthesia during cardiac surgery has been the mainstay of cardiacanesthesia for decades due to its ability to preserve hemodynamic stability and attenuate hormonal andmetabolic response to surgical stress. The hypothesis of this study is that the use of fentanyl as part of abalanced anesthetic would lead to improved patient health status and recovery during the first 3 daysafter cardiac surgery with CPB compared with morphine. Quality of recovery was assessed using theQoR-40 questionnaire administered preoperatively and daily on postoperative days 1–3. Hemodynamicvariables, duration of tracheal intubation, organ morbidities, intensive care unit (ICU) and hospitallength of stay were evaluated. Methods: This comparative randomized double blind study was conducted in the department ofcardiothoracic vascular anaesthesia and critical care of Apollo Hospitals,Dhaka on 100 patientsundergoing elective CABG. Study period was (January-July), 2019. The study was approved by theinstitutional review board, and informed consent was obtained from all subjects. One hundred patientspresenting for elective CABG surgery, between the ages of 18 and 79, were enrolled in the study. Exclusioncriteria included (1) concurrent valvular surgery or the presence of valvular disease, (2) reoperativeprocedures, (3) unstable angina or elevated cardiac enzymes within 48 hours of surgery, (4) morphine orfentanyl allergy, (5) the need for an intra-aortic balloon pump or inotropic agents preoperatively, (6)psychiatric or central nervous system disturbances precluding completion of the QoR-40. Results: Compared with patients given morphine, those receiving fentanyl had higher global QoR-40scores on postoperative days 1 (174.8 vs 162.5, P 0.001), 2 (175 vs 166.1, P 0.001), and 3 (178.1 vs 167.3,P 0.001). Differences between the groups were observed in the QoR-40 dimensions of emotional state,physical comfort, and pain . Postoperative visual analog scale pain scores, use of pain medication in theICU and surgical ward, and postoperative febrile reactions were reduced significantly in the fentanylgroup . No differences between the groups were noted in duration of tracheal intubation,ICU and hospitallength of stay, or postoperativecomplications. Conclusion: Continuous intravenous infusions of fentanyl have been used to provide intraoperativeanalgesia also give good-to-excellent postoperative analgesia furthermore early extubation and the qualityof postoperative recovery in cardiac surgical patients can be enhanced when fentanyl is used as part of abalanced anesthetic. JBSA 2020; 33(1): 28-35

Dosing of Continuous Fentanyl Infusions in Obese Children: A Population Pharmacokinetic Analysis.

Differences in fentanyl pharmacokinetics (PK) between obese and nonobese adults have previously been reported; however, the impact of childhood obesity on fentanyl PK is relatively unknown. We developed a population pharmacokinetic (PopPK) model using opportunistically collected samples from a cohort of predominately obese children receiving fentanyl per the standard of care. Using a probability-based approach, we evaluated the ability of different continuous infusion strategies to provide steady-state concentrations (Css ) within an analgesic concentration range (1-3 ng/mL). Fifty-three samples from 32 children were used for PopPK model development. Median (range) age and body weight of study participants were 13 years (2-19years) and 52 kg (16-164 kg), respectively. The majority of children (94%) were obese. A 2-compartment model allometrically scaled by total body weight provided an appropriate fit to the data. Estimated typical clearance was 32.5 L/h (scaled to 70kg). A fixed dose rate infusion of 1µg/kg/h was associated with probabilities between 49% and 58% for achieving Css within target; however, the risk of achieving Css > 3 ng/mL increased with increasing body weight (15% at 16kg vs 43% at 164kg). A proposed model-based infusion strategy maintained consistent probabilities across the examined weight range for achieving Css within (58%) and above (20%) target. Use of an allometric relationship between weight and clearance was appropriate for describing the PK of intravenous fentanyl in our cohort of predominately obese children. Our proposed model-derived continuous infusion strategy maximized the probability of achieving target Css in children of varying weights.

Infusão contínua de duas doses de fentanil associadas à lidocaína e cetamina em fêmeas caninas anestesiadas com sevoflurano e submetidas à ovariohisterectomia eletiva

O objetivo deste trabalho foi avaliar os efeitos cardiorrespiratórios de duas doses de fentanil associadas à lidocaína e cetamina em fêmeas caninas anestesiadas com sevoflurano e submetidas à ovariohisterectomia eletiva. Foram utilizados 18 animais distribuídos aleatoriamente em dois grupos. Os animais do grupo A (GA) receberam pela via intravenosa um bolus de fentanil de 0,0018 mg/kg e os do grupo B (GB) 0,0036 mg/kg, ambos associados a lidocaína 3 mg/kg e cetamina 0,6 mg/kg. Imediatamente após o bolus realizou-se a indução com propofol seguido do início da infusão contínua (IC) de fentanil na dose de 0,0018 mg/kg/h para o GA e 0,0036 mg/kg/h para GB, ambos associados a 3 e 0,6 mg/kg/h de lidocaína e cetamina. A anestesia foi mantida com sevoflurano diluído em oxigênio 100% a 1,5V% através de vaporizador calibrado que foi ajustado para a manutenção do plano anestésico cirúrgico. Os animais foram posicionados em decúbito dorsal e permaneceram sob ventilação espontânea. Foram avaliados os valores basais (T0), após indução (T1) e 5 (T5), 20 (T20) e 35 (T35) minutos de IC dos seguintes parâmetros: frequência cardíaca (FC), frequência respiratória (f), pressão arterial sistólica (PAS), diastólica (PAD) e média (PAM), saturação de oxigênio na hemoglobina (SatO2), pressão parcial de dióxido de carbônico (EtCO2) e o sevoflurano expirado (EtSevo). A analise estatística foi realizada através da análise de variância seguida do teste de Scott-knott. As diferenças foram consideradas significativas quando P &lt; 0,05. A FC reduziu após 20 minutos de IC e a f, PAS, PAD e PAM diminuíram após indução anestésica. Tais diferenças não foram relevantes clinicamente e os valores se mantiveram dentro do limite fisiológico. Pode-se concluir que as duas doses de infusão contínua de fentanil produziram estabilidade cardiovascular e respiratória, além de permitirem a diminuição do requerimento de sevoflurano para a realização da ovariohisterectomia eletiva.&#x0D;

Deep sedation for transvenous lead extraction: a large single-centre experience.

Transvenous lead extraction for cardiac implantable electronic devices (CIED) is of growing importance. Nevertheless, the optimal anaesthetic approach, general anaesthesia vs. deep sedation (DS), remains unresolved. We describe our tertiary centre experience of the feasibility and safety of DS. Extraction procedures were performed in the electrophysiology (EP) laboratory by two experienced electrophysiologists. We used intravenous Fentanyl, Midazolam, and Propofol for DS. A stepwise approach with locking stylets, dilator sheaths, and mechanical sheaths via subclavian, femoral, or internal jugular venous access was utilized. Patient characteristics and procedural data were collected. Logistic regression models were used to identify parameters associated with sedation-related complications. Extraction of 476 leads (dwelling time/patient 88 ± 49 months, 30% ICD leads) was performed in 220 patients (64 ± 17 years, 80% male). Deep sedation was initiated with bolus administration of Fentanyl, Midazolam, and Propofol; mean doses 0.34 ± 0.12 μg/kg, 24.3 ± 6.8 μg/kg, and 0.26 ± 0.13 mg/kg, respectively. Deep sedation was maintained with continuous Propofol infusion (initial dose 3.7 ± 1.1 mg/kg/h; subsequently increased to 4.7 ± 1.2 mg/kg/h with 3.9 ± 2.6 adjustments) and boluses of Midazolam and Fentanyl as indicated. Sedation-related episodes of hypotension, requiring vasopressors, and hypoxia, requiring additional airway management, occurred in 25 (11.4%) and 5 (2.3%) patients, respectively. These were managed without adverse consequences. Five patients (2.3%) experienced major intraprocedural complications; there were no procedure-related deaths. All of our logistic regression models indicated intraprocedural support was associated with administration higher Fentanyl doses. Transvenous lead extraction under DS in the EP laboratory is a safe procedure with high success rates when performed by experienced staff.

Intramuscular stimulation as a novel alternative method of pain management after thoracic surgery.

The purpose of this study was to determine whether electrical twitch-obtaining intramuscular stimulation (ETOIMS) can be an alternative to intravenous patient-controlled analgesia (IV-PCA) for postoperative pain management in pneumothorax patients undergoing single-port video-assisted thoracoscopic surgery (VATS). This preliminary prospective randomized study was conducted between March 2017 and July 2017. A total of 26 patients undergoing single-port VATS were randomly assigned to two groups: the ETOIMS group (n=12), which received intramuscular stimulation prior to chest tube insertion toward the end of procedure, and the IV-PCA group (n=14), which received continuous infusion of fentanyl with a basal rate of 10 µg/mL/h. To measure postoperative pain, visual analogue scale (VAS; range, 0-10) was used as the primary endpoint. Baseline characteristics were not different between the two groups. According to the linear mixed model, there was statistical difference in the serial VAS score between the two groups (P=0.007). The ETOIMS group showed a significantly lower VAS score compared with the IV-PCA group, especially at postoperatively hour 8, day 1, and day 2. We showed that ETOIMS may be a safe, effective, and simple alternative for pain management after single-port VATS.

Effects of a Preoperative Transdermal Fentanyl Patch on Proinflammatory Cytokine and Pain Levels During the Postoperative Period: A Randomized Controlled Trial.

Objective:The main objectives of this article were to assess the effect of preoperative transdermal fentanyl patch (TFP) on interleukin (IL)-6 and IL-8 levels and pain after laparoscopic cholecystectomy.Materials and Methods:Patients received a TFP (25 μg/h) (patch group, n=30) or a placebo patch (control group, n=30) applied 14 hours before operation. After surgery, control group received intravenous continuous fentanyl (25 μg/h) with loading dose (25 μg). IL-6 and IL-8 levels were measured at admission and 1, 6, 12, 24, and 48 hours postoperatively. Pain score and consumption of rescue analgesic were evaluated too.Results:At 24 hours postoperatively, IL-6 and IL-8 reached a peak and then decreased. The peak IL-6 levels were 21.92(±6.22) and 24.91(±6.81) pg/mL in the patch and control group. The significant differences of IL-6 between groups were shown at 6 and 12 hours postoperatively (P=0.032, 0.0001). There were no significant differences in IL-8 levels and pain score.Conclusions:Preoperative TFP attenuated the increase in IL-6 levels after surgery and provided similar analgesia to continuous fentanyl infusion. Preemptive TFP may have influence on proinflammatory reactions and pain control after surgery.