Doses Of Fentanyl Research Articles

Comparison of Dexmedetomidine and Fentanyl Infusion on Intraoperative Haemodynamic Changes in Neck Dissection

Background: Perioperative and postoperative pain control, maintenance of hemodynamic stability, proper sedation, and awakening form an integral part of anaesthetic management in head and neck surgeries. Opioids such as fentanyl are widely used for analgesia in routine anaesthetic practice. Newer non-opioid drugs such as dexmedetomidine are being increasingly used to facilitate the recovery process after surgery because of their anaesthetic and analgesic sparing effects. In this study, we compare the efficacy of dexmedetomidine and fentanyl infusion on intraoperative hemodynamic changes in neck dissection. Objectives: The aim of the study was to compare the efficacy of dexmedetomidine and fentanyl on intraoperative hemodynamic changes in neck dissection. Material and Methods: 60 male and female patients, ASA 1 and 2 aged 30–40 years scheduled for neck dissection surgeries under general anaesthesia were randomly allocated into two equal groups: Group D (n = 30) received a bolus dose of IV dexmedetomidine 1 μg/kg over 10 minutes before induction of anaesthesia and followed by infusion at the rate of 0.2 μg/kg/h during surgery. Group F (n = 30) received bolus dose of fentanyl 2 μg/kg before induction of anaesthesia and followed by infusion at the rate of 0.5 μg/kg/h during the surgery. General anaesthesia was induced in all patients using propofol and vecuronium. The following parameters were recorded: systolic blood pressure, mean arterial pressure and heart rate before and after induction of anaesthesia and then every 15 minutes till the end of surgery. Results: The intraoperative systolic blood pressure, mean arterial blood pressure and heart rate were statistically significantly (P < 0.05) lower in dexmedetomidine group compared to fentanyl group. Two patients had bradycardia in dexmedetomidine group and were responded injection atropine. Conclusion: The intravenous dexmedetomidine infusion provides stable intraoperative haemodynamics compared to fentanyl in neck dissection surgeries.

Retrospective Analysis of Factors Affecting Chronic Postoperative Pain After Thoracotomy: Single Center Experience.

Despite various pain management methods, chronic pain is still a challenging issue after thoracotomy. This retrospective study was designed to determine the possible factors affecting the development of chronic pain following open thoracotomy. The study included patients who underwent elective open thoracotomy at Ankara University İbni Sina Hospital, between 01.01.2016 and 31.12.2020. The medical files and electronic records of the patients were scanned from the system. Patient history, analgesic methods, and surgical details were recorded. The need for and usage analgesic drugs after the surgery were also recorded. A total of 229 patients who underwent thoracotomy were included in the study, and 83 (36.2%) patients had chronic pain. Duration of surgery, doses of remifentanil, fentanyl or NSAI drugs, duration or number of chest tubes (more than 4 days, or more than 2 tubes), diabetes, or PCEA usage were found as variables affecting pain. Logistic Regression, Multilayer Perceptron, Naive Bayes, AdaBoost, and Random Forest methods were used to evaluate the prediction performances. According to the model created with logistic regression, the rate of the correct classification was 90.8%. The duration of surgery, remifentanil administration, chest tube for more than 4 days, and diabetes were found to be risk factors for developing chronic pain. Fentanyl bolus, PCEA-bupivacaine, and NSAID bolus were determined as preventive factors. A careful analysis of risk factors should be performed for each patient to prevent chronic pain after thoracotomy, and preemptive effective analgesia methods should be performed.

Accelerating Remobilization Time Following Spine Surgery Using Enhanced Recovery After Surgery: A Randomized Controlled Trial

Background: The enhanced recovery after surgery (ERAS) protocol encompasses a set of evidence-based interventions implemented preoperatively, intraoperatively, and postoperatively. Objectives: This study aimed to assess the impact of applying an accelerated recovery method on remobilization time in patients undergoing spinal surgery compared to a control group. Methods: This randomized controlled trial took place at Shariati Hospital in Tehran, Iran. Eligible participants scheduled for elective spine surgery were enrolled in the study. Remobilization was defined as the patient's ability to independently leave the bed and ambulate. The ERAS protocol, derived from recommendations by the ERAS Society, was implemented. Total intravenous anesthesia was administered for induction and maintenance. The means of variables between the control and intervention groups were compared using an independent t-test. Changes in patients' pain intensity over time were examined through a repeated-measures ANOVA test. Multiple regression analysis was conducted to identify predictors of remobilization time. Results: A total of 70 patients (mean age 47.56 ± 14.08) were included in the study. The control group exhibited a significantly longer hospital stay compared to the ERAS group (46 h vs. 32 h). Furthermore, the ERAS group demonstrated a significantly shorter remobilization time after surgery compared to the control group (18 h vs. 8 h) (P < 0.001). Both groups exhibited a downward trend in overall pain, with the ERAS group experiencing a significantly faster pain reduction (η2 = 0.106, λ = 0.171, P < 0.001). Remobilization time exhibited significant correlations with pain intensity immediately after surgery (r = 0.651, P < 0.001), pain intensity one hour after surgery (r = 0.723, P < 0.001), pain intensity six hours after surgery (r = 0.391, P = 0.001), fentanyl dose (r = 0.728, P < 0.001), and length of hospital stay (r = 0.727, P < 0.001). Multiple regression analysis revealed that pain intensity one hour after surgery, fentanyl dose, and hospital stay significantly predicted remobilization time (F (9,60) = 22.751, P < 0.001). Conclusions: The implementation of the ERAS protocol yielded several beneficial outcomes, including reduced pain intensity, shorter ICU and hospital stays, and accelerated remobilization time. Pain intensity and opioid consumption (as analgesia) emerged as significant predictors of remobilization time.

Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE): Trial of Fentanyl versus Fentanyl + Dexmedetomidine for Maintenance of Sedation

Abstract Objectives This article observes the mean daily dose of fentanyl required for adequate sedation in critically ill, mechanically ventilated children randomized to receive dexmedetomidine or placebo. Methods We conducted Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE), a multicenter, double-blind, randomized, placebo-controlled, dose-escalating trial. We enrolled children aged 35 weeks postmenstrual to 17 years (inclusive) admitted across 13 pediatric multidisciplinary and cardiac intensive care units. Adequate sedation was based on a State Behavioral Score and Richmond Agitation-Sedation Scale of –1 or lower. Only the first two dexmedetomidine dosing cohorts opened for enrollment, due to early trial closure during the coronavirus 2019 pandemic. Thirty children were randomized over 13 months and included in the analyses. Results Demographic and baseline characteristics were not different between dexmedetomidine and placebo cohorts. Similarly, mean daily fentanyl use was not different, using an unadjusted mixed regression model that considered treatment, time, and a treatment-by-time interaction. Adverse events and safety events of special interest were not different between cohorts. Conclusion The DOSE trial revealed that dexmedetomidine added to fentanyl does not impact safety and may not spare fentanyl use in critically ill children, although the trial did not meet its recruitment goals, due to early closure during the coronavirus 2019 pandemic. More rigorous inpatient pediatric trials like DOSE that study critically ill, mechanically ventilated children are needed. Despite the many obstacles faced, the DOSE trial presents challenges from which the greater research community can learn and use to optimize future therapeutic trials in children.

Is OPRM1 genotype a valuable predictor of VAS in patients undergoing laparoscopic radical resection of colorectal cancer with fentanyl?

ObjectiveThis study was conducted to examine the association between the A118G polymorphism of the OPRM1 gene and the risk of increased VAS scores in patients with colorectal cancer who underwent laparoscopic radical resection for which fentanyl was used.MethodsThe OPRM1 A118G genotype in subjects were detected. The relationship between the A118G polymorphism of the OPRM1 gene and increased Visual Analogue Scale (VAS) scores throughout the perioperative period was explored. A total of 101 patients receiving fentanyl anesthesia undergoing laparoscopic radical resection of colon tumors at Zhongshan Hospital, Fudan University between July 2018 and December 2020 were investigated in the present study. The relative risk between the A118G polymorphism of the OPRM1 gene and VAS ≥ 4 in the PACU was estimated using the adjusted effect relationship diagram, baseline characteristic analysis, and multiple logistic regression analysis. The relationship between the A118G polymorphism of the OPRM1 gene and VAS in the PACU, as well as perioperative fentanyl usage, was examined after confounders were adjusted.ResultsSubjects with OPRM1 A118G wild gene A were less sensitive to fentanyl, which was a risk factor for PACU VAS ≥ 4. Before the model was adjusted, the odds ratio (OR) was 14.73 (P = 0.001). After adjusting for age, sex, weight, height, and the duration of surgery, the OR increased to 16.55 (P = 0.001). When adjusting for age, sex, weight, height, surgery duration, COMT Val158Met gene polymorphism, CYP3A4 *1G gene polymorphism, and CYP3A5 *3gene polymorphism, the OR was 19.94 (P = 0.002). Moreover, OPRM1 A118G wild type gene A was found to be a risk factor for increased dosage of fentanyl in the PACU. Before the model was adjusted, the OR reached 16.90 (P = 0.0132). After adjusting for age, sex, body weight, intraoperative fentanyl dosage, surgery duration, and height, the OR was 13.81, (P = 0.0438). When adjusting for age, sex, weight, height, intraoperative fentanyl dosage, surgery duration, COMT Val158Met gene polymorphism, CYP3A4 *1G gene polymorphism, and CYP3A5 *3 gene polymorphism, the OR reached 15.23, (P = 0.0205).ConclusionThe A118G polymorphism of the OPRM1 gene carrying wild gene A was a risk factor for VAS ≥ 4 in the PACU. Moreover, it is a risk factor for increased dosage of fentanyl in the PACU.

Comparing intraoperative hemodynamics and medication use during cranial nerve monitoring with partial muscle relaxants versus without in cerebellopontine angle tumors: a randomized controlled trial

BackgroundThere are many methods used for cranial nerve monitoring in cerebellopontine angle (CPA) tumor excision with or without muscle relaxant which may affect hemodynamics and consumption of drug doses. The partial neuromuscular blockade, on the other hand, appears to be compatible with monitoring in some patients, according to clinical experience. In this study, we evaluated hemodynamic changes and drug consumption differences between partial and without muscle relaxants.Forty patients ages ranging from 18 to 60 years old had CPA surgery and were given either a muscle relaxant to maintain neuromuscular blockade level train-of-four (TOF) count two (group A) or a placebo of normal saline to maintain train-of-four (TOF) count four (group B). Fentanyl was given to both groups. The dose of fentanyl was modified to 0.5–1 mcg\\kg/h, while the dose of propofol was modified to have bi-spectral index between 40 and 60. The total amount of propofol and fentanyl, as well as mean blood pressure and heart rate, are all measured intraoperatively.ResultsThere was a statistically significant difference in propofol and fentanyl doses between both research groups (p = 0.003, p = 0.002) respectively during the intraoperative period. Furthermore, there is a difference in as there were significant differences between two groups in time between stop of anesthesia and eye opening which is shorter in group with partial muscle relaxant reflecting shorter duration of anesthesia and recovery time (stop anesthesia to eye opening time) (p = 0.003, p > 0.001) respectively. Also, there was no statistically significant difference in the incidence of nausea and vomiting, shivering, bradycardia, or hypotension between the two study groups.ConclusionsWe demonstrated that partial muscle relaxant (train of four count 2) has benefits over no muscle relaxant (train of four count 4) for patients undergoing cerebellopontine angle tumor surgery because it can reduce anesthetic duration and generate rabid recovery. Furthermore, partial muscle relaxants exhibit the same hemodynamic stability, side effects, and surgical interruptions as group without muscle relaxants.

Influence of fentanyl-based Patient-Controlled Intravenous Analgesia (PCIA) with and without background infusion on postoperative pain intensity in patients following total hip replacement

ABSTRACT Objective The goal of this trial was to determine if fentanyl PCIA and background infusion are effective for post-total hip replacement analgesia. Methods This trial examined two groups of patients receiving PCIA who had total hip replacements: group A (n = 35) with no background infusion, lockout time of 6 min; group B (n = 35) with background infusion 2 mL/h infusion, lockout time of 10 min. The fentanyl dose in each group was diluted with 100 mL normal saline. Primary outcome was VAS scores at rest after 24 hr. The secondary outcomes included VAS scores at rest at 6, 12, and 18 hr, fentanyl consumption, injection to attempt ratio, blood pressure, and heart rate. Results Neither background infusion nor no background infusion showed significant differences in VAS scores at 24 hr. Background infusion groups exhibited lower VAS pain levels at 6, 12, and 18 hr. At 24 hr after surgery, attempts, injections, and fentanyl consumption were significantly different between the two groups (P < 0.001). While BP and HR did not differ significantly between groups, pain control effectiveness showed statistically significant differences between groups. Conclusion Background infusion increased the overall quantity of fentanyl consumed within 24 hr after total hip replacement. The background infusion considerably decreased the pain at 6, 12, and 18 hr, but it had little effect on hip replacement pain at 24 hr. Importantly, it did not increase the incidence of BP, and HR. However, there were no significant differences in BP or HR between both groups, Fentanyl Background infusion was effective for post-total hip replacement analgesia.

A Preliminary Feasibility Study on Hemodynamic Changes Following Feyh-Kastenbauer Retractor Insertion During Transoral Robotic Surgeries.

Introduction Transoral robotic surgery (TORS) has become increasingly popular for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes. Feyh-Kastenbauer (FK) retractor is one such routinely used retractor during TORS. The setting up of this retractor has been seen to be accompanied by hemodynamic fluctuations. Methodology This prospective observational study was carried out on 30 patients undergoing TORS. All patients were administered general anesthesia using a pre-defined anesthesia protocol. The primary outcome was to compare hemodynamic fluctuations following endotracheal intubation with that after FK retractor insertion. Any requirement of a bolus dose of sevoflurane and fentanyl was recorded in response to hemodynamic fluctuations recorded in secondary outcomes. Results There was no statistically significant increase in mean heart rate, systolic, diastolic, and mean arterial blood pressure from baseline to endotracheal intubation and following retractor insertion (p=0.810, p=0.2, p=0.6, p=0.3 respectively). On subgroup analysis, hypertensive patients reported a greater rise in blood pressure following two minutes post FK retractor insertion compared to non-hypertensive patients (p=0.03). Out of 30 patients, five patients required a bolus dose of sevoflurane. Conclusion FK retractor insertion had a comparable hemodynamic response as endotracheal intubation during TORS. Hypertensive patients showed a rise in blood pressure at both endotracheal intubations and at FK retractor insertion.

Genome-Wide Association Study Identifies Genetic Polymorphisms Associated with Estimated Minimum Effective Concentration of Fentanyl in Patients Undergoing Laparoscopic-Assisted Colectomy.

Sensitivity to opioids varies widely among individuals. To identify potential candidate single-nucleotide polymorphisms (SNPs) that may significantly contribute to individual differences in the minimum effective concentration (MEC) of an opioid, fentanyl, we conducted a three-stage genome-wide association study (GWAS) using whole-genome genotyping arrays in 350 patients who underwent laparoscopic-assisted colectomy. To estimate the MEC of fentanyl, plasma and effect-site concentrations of fentanyl over the 24 h postoperative period were estimated with a pharmacokinetic simulation model based on initial bolus doses and subsequent patient-controlled analgesia doses of fentanyl. Plasma and effect-site MECs of fentanyl were indicated by fentanyl concentrations, estimated immediately before each patient-controlled analgesia dose. The GWAS revealed that an intergenic SNP, rs966775, that mapped to 5p13 had significant associations with the plasma MEC averaged over the 6 h postoperative period and the effect-site MEC averaged over the 12 h postoperative period. The minor G allele of rs966775 was associated with increases in these MECs of fentanyl. The nearest protein-coding gene around this SNP was DRD1, encoding the dopamine D1 receptor. In the gene-based analysis, the association was significant for the SERP2 gene in the dominant model. Our findings provide valuable information for personalized pain treatment after laparoscopic-assisted colectomy.

Evaluation of the Efficacy of Magnesium Sulfate in Reducing Blood Loss in Functional Endoscopic Sinus Surgery: A Randomized Double-Blinded Controlled Trial.

Objectives The primary concern in functional endoscopic sinus surgery (FESS) is maintaining a clear and unobstructed surgical field. Achieving this objective necessitates controlled hypotension, which can aid in the surgical dissection process and reduce the overall duration of the operation. This study aims to evaluate the efficacy of a sole bolus injection of intravenous magnesium sulfate in FESS. The outcomes measured include blood loss, surgical field grading, the additional intraoperative requirement of fentanyl, stress attenuation during laryngoscopy and endotracheal intubation, and extubation time. Methods In this prospective, double-blinded, randomized control trial (CTRI/2021/04/033052), 50 patients scheduled for FESS were randomly divided into two groups: Group M received 50 mg/kg MgSO4 in 100 ml normal saline, and Group N received 100 ml plain normal saline 15 min before induction. The study assessed total blood loss, measured by blood collected from the surgical field and weighing gauze. The surgical field grading was assessed by a six-point Fromme and Boezaart scale. We also observed stress attenuation during laryngoscopy and endotracheal intubation, additional intraoperative fentanyl requirements, and time taken for extubation. The sample size was estimated using the G power calculator 3.1.9.2 (http://www.gpower.hhu.de/). Data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using Statistical Package for Social Sciences version 20.0 (IBM Corp., Armonk, NY). Results The demographic data and duration of the surgery were comparable in both groups. The total blood loss in Group M was 100.40 ml ±60.71 ml, which is lower than Group N (133.80 ml ±59.7 ml) with a p-value of 0.016. In addition, the surgical field grading was also better in Group M. The total vecuronium consumption was significantly lower in Group M, which was (7.23±0.84 mg); in Group N, it was (10.64±1.74 mg) with a p-value of 0.0001, respectively. The dosage of additional fentanyl in Group N was 38.46 mcg ± 8.99 mcg, more than in Group M (33.64 mcg ± 11.20 mcg). The time required for extubation was similar in both groups. The duration of the surgery was significantly more significant in Group M (150.0 ±31.36) than in Group N (205.0 ±32.79), with a p-value of 0.0001, respectively. Furthermore, the mean arterial pressure after induction, at 2 min and 4 min after laryngoscopy, was less in Group M, with p=0.001, p=0.003, and p<0.0001, respectively, when compared with Group N. The heart rate after induction, at 2 min and 4 min after laryngoscopy, was also less in Group M, with p=0.016, p=0.003, and p=0.003, respectively, when compared with Group N. The Ramsay Sedation Score was higher in Group M than in Group N's fourth, eighth, and sixteenth hour, with p=0.001, p=0.021, and p=0.001, respectively, in the postoperative period. The sedation score was statistically insignificant after that. No complications were encountered during the study. Conclusion We conclude that a single bolus dose of MgSO4 reduced surgical blood loss more effectively than in the control group. The surgical field grading was also better in Group M, as was the stress attenuation during laryngoscopy and endotracheal intubation. The intraoperative fentanyl requirement was not statistically significant. The time for extubation was similar between the groups. No other adverse effects were encountered during the study.

Weaning from high-dose opioids (fentanyl and oxycodone) two case reports

We present two cases of weaning from high-dose opioids (fentanyl and oxycodone. The first case concerns a 26-year-old patient with mitochondrial syndrome and neuropathic pain in the lower limbs, addicted to high doses of transdermaland transmucosal fentanyl (transdermal fentanyl 150 g/h in the form of patches every 3 days and transmucosalfentanyl 300 g/dose applied intranasally every 1 hour). The second case concerns a 32-year-old patient with chronicpost-traumatic pain and post-traumatic stress disorder, addicted to a high dose of oxycodone (1600 mg/day).Unfortunately, only in the first case, the desired effect was achieved discontinuation of fentanyl and remission of pain.In the second case, the patient resigned from further treatment in the pain management clinic despite achieving theintended therapeutic effect switching oxycodone to buprenorphine and reducing pain intensity

Prevalence and Risk Factors for Iatrogenic Opioid Withdrawal in Medical Critical Care Patients.

To identify the and risk factors for IWS in adult patients admitted to critical care medicine services who received greater than or equal to 24 hours of continuous opioid infusion therapy. A prospective, observational study was conducted in a tertiary care hospital in adult medical ICU patients. Ninety-two patients who received greater than or equal to 24 hours of continuous opioid infusions were included in the study. Patients were assessed daily after opioid infusion discontinuation using the Clinical Opiate Withdrawal Scale (COWS) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) opioid withdrawal criteria for a maximum of 5 days. The primary outcome was the prevalence of IWS of moderate severity or greater using COWS. Secondary outcomes included the prevalence of IWS diagnosis of any severity based on COWS, the prevalence of IWS diagnosis based on a positive DSM-V score, and the identification of potential risk factors for developing IWS of any severity. Four hundred forty-seven patients received greater than or equal to 24 hours of continuous opioid therapy. Of these, 385 were excluded, leaving 92 patients included in the final analysis. Except for a higher prevalence of psychiatric history in the IWS-positive group, baseline characteristics were similar. Overall, 11 patients (12%) developed IWS of moderate severity or greater, based on COWS. The IWS-positive group also had longer durations of opioid infusions, higher cumulative opioid infusion doses, higher mean daily doses, and higher infusion rates at any given time. The concomitant use of dexmedetomidine (38.3 vs 15.6%, p = 0.014) and benzodiazepines (63.8 vs 37.8%, p = 0.021) during or after the opioid infusion were significantly higher in the IWS-positive group compared with the IWS-negative group. No significant differences were found between the two groups for scheduled or as needed opioids after cessation of the opioid infusion. Continuous opioid infusions greater than or equal to 72 hours and total daily dose greater than or equal to 1,200 μg were found to be independent predictors for the development of iatrogenic opioid withdrawal via logistic regression. Approximately one in every eight patients receiving continuous infusion opioid for greater than 24 hours while mechanically ventilated in the medical ICU will develop IWS of moderate severity or greater; this increases to one in three patients diagnosed with DSM-V criteria or any level of IWS severity. Patients receiving opioid infusions greater than or equal to 72 hours, or a total daily fentanyl dose of greater than or equal to 1,200 μg (~ 50 μg/hr) are at a higher risk for developing IWS and should be monitored as part of clinical practice when opioid infusions are discontinued.

Modulation of opioid overdose susceptibility due to context-dependent tolerance

The US is in the midst of an opioid epidemic, which is primarily being driven by repeat opioid use (ROU). The primary cause of opioid overdose is opioid-induced respiratory depression (OIRD). It has been shown that the risk of overdosing, and subsequently death, can change depending on the environment in which the user takes the drug. This phenomenon is called context-dependent tolerance. However, how OIRD changes depending on the location of drug delivery is not known. The objective of this pilot study is to investigate context-dependent respiratory tolerance to OIRD and overdose. We repeatedly paired an injection of fentanyl (0.7 mg/kg/day i.p.) with a distinctive environmental context (fentanyl-paired (FP) environment) and saline with another distinctive context (saline-paired (SP) environment) in adult mice for five days while monitoring breathing via unrestrained whole-body plethysmography. The ROU protocol was followed by two test days where fentanyl was administered in both environments and breathing was measured. We found that minute ventilation was greater during OIRD in the FP environment as compared to the SP environment (n=4). In the second set of mice (n=6?), we tested overdose susceptibility following ROU by administering a high dose of fentanyl (5mg/kg) in both contexts. In contrast to the FP environment where no mice overdosed (n=0/6), n=4/6 mice overdosed in the SP environment. These data suggest a greater susceptibility to OIRD and overdose when in an environment not previously paired with fentanyl administration. This context-dependent effect on OIRD may be a significant psychophysiological factor driving opioid-related deaths in the ongoing opioid epidemic. NIH: R01NS107421; R01HL163965; R01DA057767. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Fentanyl disrupts autoregulation and leads to exacerbated vasodilation in resistance arteries independent of mu-opioid receptor activation

According to the CDC, 107,375 people in the United States died of drug overdoses and poisonings in the 12-month period ending in January 2022 with 67% involving synthetic opioids like fentanyl. Recent studies have implicated the use of prescription opioids as a risk factor for cardiovascular diseases (CVD), with reported associations including myocardial infarction, coronary artery disease and vascular deterioration. With small doses of fentanyl being particularly dangerous to those who have little to no tolerance, our primary hypothesis was that acute exposure to fentanyl will abolish myogenic activity and induce exacerbated vasodilation. While the mu-opioid receptor (MOR) serves as the primary target for exogenous opioids, it has been shown that the endogenous opioids like spinorphin can induce calcium flux in neutrophils via the N-formyl peptide receptor (FPR-1). With this premise, our second hypothesis was that the vasodilatory effects of fentanyl were in part contributed by inhibition of FPR1. To test these hypotheses, mesenteric resistance arteries were isolated from 12-13-week-old male C57BL/6J mice and vascular function evaluated. Myogenic tone was evaluated via a pressure-response curve (10-140 mmHg) after a 30-minute incubation with fentanyl 10 -6 M. Contractility was evaluated via concentration-response curves to phenylephrine (Phe) in arteries pretreated with: Fentanyl 10 -6 M (Fen), Naloxone 10 -5 M (Nal, MOR antagonist), Naloxone 10 -5 M+Fentanyl 10 -6 M (Nal+Fen), Cyclosporin H 10 -5 M (Cyclo, FPR-1 antagonist), or Cyclosporin H 10 -5 M+Fentanyl 10 -6 M (Cyclo+Fen). Arteries were incubated with antagonists 15 minutes prior to a 30-minute fentanyl incubation. Control (Cont) levels were established prior to any incubations. Pressure data were analyzed using student t test and contractility data using one way anova (p&lt;0.05* vs Cont). Fen abolished myogenic tone in arteries when compared to Cont at 40 mmHg (Cont 7.8±2.2 vs Fen 1.5±1.5*, %, n=3). Further, Fen significantly decreased contraction when compared to Cont [Area under the curve (AUC): Cont 54±5 vs. Fen 15±3 n=4*]. However, the presence of the antagonists for FPR-1 [AUC: Fen 15±3 vs. Cyclo+Fen 12 ±2, n=4, p&gt;0.05) or mu-opioid receptor (AUC: Fen 15±3, vs. Nal+Fen 13±2, n=4, p&gt;0.05) did not change these responses. The presence of the antagonists alone decreased contraction. This suggests a constitutive effect of FPR-1 or mu-opioid receptor on Phe-induced contractility (AUC: Cont 54±5 vs. Nal 32±10* vs. Cyclo 17±2*). Overall, our data suggest that acute treatments of Fentanyl lead to a significant disruption of autoregulation and exacerbated vasodilation in resistance arteries independent of mu and FPR-1 receptors. Therefore, chronic exposure to this opioid may lead to dysfunction and loss of myogenic tone and, subsequently, CVD. R00GM118885, R01HL149762, R00HL151889, and NHLBI (R00HL151889) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Does the combination of intrathecal fentanyl and morphine improve clinical outcomes in patients undergoing lumbar fusions?

Intrathecal morphine (ITM) has been widely effective in improving postoperative outcomes in patients undergoing a multitude of surgeries, including lumbar spine fusion. A major limitation of ITM administration is the increase in the incidence of respiratory depression in a dose-dependent manner. One way to bypass this is to use a more potent opioid with a shorter half-life, such as fentanyl. This is a retrospective analysis of patients who underwent one- or two-level transforaminal lumbar interbody fusions. The patients received one of two interventions: 0.2mg intrathecal duramorph/morphine (ITM group; n=70), 0.2mg duramorph + 50 mcg fentanyl (ITM + fentanyl group; n=68) and the control group (n=102). Primary outcomes included postoperative pain (Visual Analog Scale) and opioid intake (MED - morphine equivalent dosage, mg) for postoperative days (POD) 1- 4. Secondary outcomes included opioid-related side effects. One-way analyses of variance and follow-up post-hoc Tukey's honest significant difference statistical tests were used to measure treatment effects. Significantly lower POD1 pain scores for both the ITM and ITM + fentanyl groups vs. control were detected, with no difference between the ITM vs. ITM + fentanyl groups. Similar results were found for POD1 MED intake. A multivariate regression analysis controlling for confounding variables did not attenuate the differences seen in POD1 pain scores while revealing that only the ITM + fentanyl predicted a decrease in POD1 MED intake. No differences were seen for postoperative opioid-related side effects. Our study provides support for supplementing a low dose of both intrathecal morphine and fentanyl to improve postoperative outcomes.

Caudal block in combination with general anesthesia as the best method of anesthesia for large joint replacement

Operations of total hip and knee arthroplasty are currently one of the most frequent surgical interventions performed for functional rehabilitation of patients with osteoarthritis or patients who have received a fracture of the femoral neck. The best method for providing anesthesia and pain relief for total joint replacement has not been determined. Until now, a unified point of view on the choice of the optimal method of anesthesia and analgesia in surgical interventions for arthroplasty has not been formed. Purpose of the study.: To study the effectiveness of caudal anesthesia in hip and knee arthroplasty. Material and research methods: The study was conducted in the surgical clinic of the AMU in 56 patients who underwent surgery for hip and knee arthroplasty. The age of the patients varied from 57 to 99 years. Depending on the chosen anesthesia technique, the patients were divided into 2 groups: in the 1st group (n=28) endotracheal anesthesia was performed, induction of anesthesia with propofol and rocuronium bromide, anesthesia based on sevoflurane 1.0 vol% with caudal administration of ropivacaine 2 mg/kg in combinations with dexamethasone 0.2 mg/kg; group 2 (n=28 patients) underwent multicomponent endotracheal anesthesia (propofol 3 mg/kg, rocuronium bromide 0.6 mg/kg, sevoflurane 1.5–2.5 vol/% with high doses of fentanyl 5–6 µg /kg/hour. Research results: During the traumatic moment of the operation, the average heart rate in group I (general anesthesia + caudal block) was significantly lower than in group II (general anesthesia) (69.4±2.0 versus 89.40±3.0, p=0.010), but there are significant differences in SBP or DBP between the two groups. Conclusion: The inclusion of caudal blockade in the protocol of general anesthesia provides adequate pain relief, both intra- and postoperatively, in patients undergoing arthroplasty of large joints of the lower extremities.

The association of patient age, race, and demographic features on reported pain and sedation dosing during procedural abortion: A retrospective cohort study

ObjectivesTo explore impact of age, racial, demographic, and psychosocial factors on patients’ dosage of analgesia and maximum pain score during procedural abortion. Study designWe performed retrospective chart review of pregnant individuals undergoing procedural abortion at our hospital-based abortion clinic from October 2019 through May 2020. Patients were stratified into age groups,<19 years, 19 to 35 years, and>35 years. We conducted the Kruskal-Wallis H test to evaluate for medication dosing or maximum pain score differences among groups. ResultsWe included 225 patients in our study. We found no difference in fentanyl or midazolam dosing by age. The median fentanyl dose was 75 mcg and median midazolam dose was 2 mg in all three groups (p = 0.61, p = 0.99). White patients received higher median midazolam dosing than Black patients (2 and 3 mg, respectively, p < 0.01) despite similar pain scores. Despite no difference in pain scores, patients terminating for genetic anomaly received more fentanyl than those terminating for socioeconomic reasons (75 and 100 mcg, respectively, p < 0.01). ConclusionsIn our limited study, we found that White race and induced abortion for genetic anomaly were associated with increased medication dosing, though age was not. Multiple demographic and psychosocial factors, as well as perhaps provider bias, play into both a patient’s perception of pain and the dosage of fentanyl and midazolam they receive during abortion procedures. ImplicationsBy acknowledging both patient factors and provider biases in medication dosing, we can provide more equitable abortion care.

Levels and predictors of patient satisfaction during flexible bronchoscopy procedures.

Flexible bronchoscopy (FB) is a safe and commonly performed procedure in pulmonary medicine. Bronchoscopy literature mainly focusing on technical aspects. However, data on patients satisfaction and bronchoscopy is rare. To evaluate levels and factors affecting patient satisfaction with flexible bronchoscopy (FB). This prospective study, conducted between June 2017 and May 2019 at King Abdulaziz University Hospital (Jeddah, Saudi Arabia), included all consecutive diagnostic bronchoscopies for adult patients. Patient willingness to return for another bronchoscopy (definitely not, probably not, unsure, probably would, or definitely would) was used as the indicator of satisfaction. Patients ranked their experiences with doctors, nurses, and process of care using a 5-choice scale (poor, fair, good, very good, or excellent). A total of 351 patients participated in this study. Overall, patients were highly satisfied with their doctors, nurses, and process of care. However, only 34.1% of patients indicated that they would return for another FB if necessary. Predictors of return for FB were younger age (<65 years), university education, use of midazolam and higher doses of fentanyl >100 mcg, and inpatient setting. Logistic regression demonstrated that younger age (P = 0.005) and inpatient setting (P = 0.02) were significantly linked to willingness to return for bronchoscopy. Patient satisfaction with bronchoscopy was lower in our study compared to other studies, despite high ratings of doctors' and nurses' skills. Elderly patients and patients with outpatient bronchoscopies were less likely to return and should therefore be approached with extra care. Physicians can improve FB-related patient experiences by decreasing discomfort during bronchoscope insertion and by improving topical anesthesia.

Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial

BackgroundBariatric surgery depends on the development of novel anesthetic techniques to reduce the incidence of complications and improve postoperative outcomes. Ketamine and dexmedetomidine have been used for perioperative analgesia and we hypothesized that they would decrease postoperative morphine requirements. The objective of this trial is to study whether choice of ketamine or dexmedetomidine infusion would affect postoperative total morphine consumption.MethodsNinety patients were equally randomized into three groups. The ketamine group received a bolus dose (0.3 mg/kg) of ketamine over 10 min, followed by an infusion of the same drug (0.3 mg/kg/h). The dexmedetomidine group received a bolus dose (0.5 mcg/kg) of dexmedetomidine over 10 min, followed by an infusion of this drug (0.5 mg/kg/h). The control group received a saline infusion. All infusions were given till 10 min before the end of surgeries. Intraoperative fentanyl was given when patient developed hypertension and tachycardia despite adequate anesthesia and muscle relaxation. Postoperative pain was managed by a rescue dose of 4 mg of IV morphine, with a minimum interval of 6 h between morphine doses if the numerical rating scale (NRS) score was ≥ 4. The primary outcome was the total morphine dose, and the secondary outcomes were intraoperative fentanyl requirement, time to extubation, postoperative nausea and vomiting (PONV), NRS scores, and modified observer’s agitation/sedation scale (MOASS) scores.ResultsCompared with ketamine, dexmedetomidine decreased the need for fentanyl intraoperatively (160 ± 42 µg), shortened the time to extubation (3 ± 1 min), and improved MOASS and PONV scores. In turn, ketamine decreased postoperative NRS scores and the need for morphine (3 ± 3 mg).ConclusionsDexmedetomidine treatment was associated with lower fentanyl doses, a shorter time to extubation, and better MOASS and PONV scores. Ketamine treatment was associated with significantly lower NRS scores and morphine doses. These results indicated that dexmedetomidine effectively decreased intraoperative fentanyl requirement and the time to extubation, while ketamine decreased the need for morphine.Trial registrationThis trail was registered on the clinicaltrials.gov registry (NCT04576975) on October 6, 2020.

THORACIC SEGMENTAL SPINAL ANAESTHESIA/ GENERAL ANAESTHESIA FOR LAPROSCOPY SURGERY

Background:Laparoscopic surgeries are usually done under general anesthesia, but many patients with major medical problems sometimes cannot tolerate such anesthesia, and thoracic spinal anesthesia may be beneficial in such patients. A comparative study between two groups of patients using either general anesthesia or segmental thoracic spinal anesthesia. Aim &amp; objectives:The aim of this study is to compare mean hospital stay, patient, and surgeon satisfaction between two groups of healthy patients operated for various laparoscopic surgeries under general and segmental thoracic spinal anesthesia. Study period&amp;place:December 2022-January2023 ( 1 month),in Narendra Modi Medical collage&amp; L.G hospital,Ahmedabad. Patients and methods:Thirty adult patients of ASA I or II grade undergoing various laparoscopic surgeries, randomly divided into two groups of 15 patients each. Group G received conventional general anesthesia with endotracheal intubation and mechanical ventilation through Drager Fabious GS workstation.Group S received a segmental (T 7-8 inj.) thoracic spinal anesthesia using 1 .5ml of plain levobupivacaine 0.5% (7.5 mg) in addition to 25 μg fentanyl. In group G,after pneumoperitoneum for haemodynamic changes( hypertension,tachycardia) iv fentanyl alliquotes,increase sevoflurane concentration,needed.In cases not responding to them inj.Nitroglycerin infusion was given. In group S, drugs to manage patient anxiety or hemodynamic fluctuations (bradycardia or hypotension) were given when needed. Intraoperative haemodynamic monitoring, postoperative pain, complications, recovery time by modified alderte score&gt;8 and patient &amp; surgeon satisfaction,mean hospital stay were compared between the two groups. Results: In the GroupS, spinal anesthetia was performed easily in all 15 patients, although two complained of paresthesia, which respondedto slight needle withdrawal the block was effective for surgery in all patients, and five experienced some discomfort, shoulder pain which was readily treated with small doses of fentanyl, but none required conversion to general anesthesia five patients required midazolam for anxiety, six patients required mephentermine and atropine for hypotension and bradycardia, and recovery was uneventful and without sequelae. In group G,3(20%) patients required infusion of Nitroglycerin for hypertension&amp; 5(33%) patient required 2 times fentonyl alliquotes of 50 mcg iv.,3(20%) patients required increase concentration of sevoflurane ( upto 5%) Conclusion: Patients of Thoracic segmental spinal anesthesia group had shorter discharge time( time to achieve modified alderte acore&gt;8) and better patient satisfaction. Surgeon satisfaction was higher in general anesthesia group. Segmental thoracic spinal anesthesia can be used successfully and effectively for laparoscopic surgery.