Intravenous Fentanyl Research Articles

Major Pelvic Ortho-oncological Surgeries: Our Experience

Background and Aims: Anaesthesia for pelvic tumour surgeries is challenging because of major blood loss, extensive tissue damage, hypothermia due to the longer duration of surgery, unusual and frequent change in positions, ongoing postoperative blood loss and post-operative pain management. This retrospective study aimed to assess the perioperative anaesthetic management for patients undergoing major pelvic tumour surgeries in our institute. Methods: We collected data from 20 patients from the patient files, anaesthesia records and electronic medical records about demographics, type and duration of surgery, pre-operative morbidities, preoperative chemotherapy/radiotherapy, intraoperative anaesthesia management with respect to fluids, blood loss, blood products transfused and postoperative pain management and complications. Data were summarised using percentages for categorical data and medians for continuous data. Results: Sixteen patients were given epidural and general anaesthesia, while four were given only general anaesthesia. The median duration of surgery was 7 h (interquartile range [IQR] 5–10 h). Multiple surgeons were involved in four cases. The median blood loss was 1500 ml (IQR 550–2750 mL); nine patients needed massive blood transfusions. Navigation-guided surgical cuts were made in eight patients. Three required postoperative mechanical ventilation. The pain was managed by epidural infusions and intravenous patient-controlled fentanyl infusions. The postoperative complication was seen in two patients in the form of wound infection and a post-operative bleed. Conclusion: The major pelvic orthopaedic oncological surgeries require meticulous attention to patient-centric perioperative care. A dedicated team approach with a definitive surgical plan, anticipating complications and their timely intervention, pain management and postoperative rehabilitation can lead to improved outcomes.

Transcriptional signatures of fentanyl use in the mouse ventral tegmental area.

Synthetic opioids such as fentanyl contribute to the vast majority of opioid-related overdose deaths, but fentanyl use remains broadly understudied. Like other substances with misuse potential, opioids cause lasting molecular adaptations to brain reward circuits, including neurons in the ventral tegmental area (VTA). The VTA contains numerous cell types that play diverse roles in opioid use and relapse; however, it is unknown how fentanyl experience alters the transcriptional landscape in specific subtypes. Here, we performed single nuclei RNA sequencing to study transcriptional programs in fentanyl-experienced mice. Male and female C57/BL6 mice self-administered intravenous fentanyl (1.5μg/kg/infusion) or saline for 10days. After 24 h abstinence, VTA nuclei were isolated and prepared for sequencing on the 10× platform. We identified different patterns of gene expression across cell types. In dopamine neurons, we found enrichment of genes involved in growth hormone signalling. In dopamine-glutamate-GABA combinatorial neurons, and some GABA neurons, we found enrichment of genes involved in Pi3k-Akt signalling. In glutamate neurons, we found enrichment of genes involved in cholinergic signalling. We identified transcriptional regulators for the differentially expressed genes in each neuron cluster, including downregulated transcriptional repressor Bcl6, and upregulated transcription factor Tcf4. We also compared the fentanyl-induced gene expression changes identified in mouse VTA with a published rat dataset in bulk VTA, and found overlap in genes related to GABAergic signalling and extracellular matrix interaction. Together, we provide a comprehensive picture of how fentanyl self-administration alters the transcriptional landscape of the mouse VTA that serves as the foundation for future mechanistic studies.

The efficacy of rhomboid intercostal block for pain management after video-assisted thoracoscopic surgery: a prospective, randomized-controlled trial.

We aimed to evaluate the efficacy of rhomboid intercostal block (RIB) for analgesia management in patients who underwent video-assisted thoracoscopic surgery. Adult patients who underwent VATS under general anesthesia between July 2020 and June 2022 were included in the study. There was two groups in this study: RIB (n = 25) vs control (n = 25) group. RIB was performed with 30 ml 0.25% bupivacaine at the end of the surgery. Surgical intercostal blockade was performed with 30 ml 0.25% bupivacaine in the control group. The patients received intravenous fentanyl patient-controlled postoperative analgesia. The numerical rating score (NRS), opioid consumption, and adverse events were recorded. A total of 50 patients were randomized into 2 groups. There were no significant difference in terms of the demographic data between groups (P > 0.05). Postoperative opioid consumption at 0-8, 8-16, 16-24, and 24-48 h and rescue analgesic use were significantly lower in RIB group (P < 0.05). At all times, the static/dynamic NRS were significantly lower in RIB group. The rate of nausea and itching was higher in control group (P < 0.05). US-guided RIB provides effective post-VATS analgesia.

IUD Insertion Under Conscious Sedation: Patient Characteristics with Clinical Decisions

Study ObjectiveUptake of intrauterine devices (IUDs) in the adolescent population may be limited by anxiety and pain anticipated during the insertion procedure. Our institution offers conscious sedation for IUD insertion to mitigate this concern. The objective of this study was to identify characteristics and outcomes of teens choosing between two types of conscious sedation for insertion of a levonorgestrel IUD. MethodsThis was a single-site, retrospective cohort study over a one-year period reviewing the electronic medical record of patients who had an attempted IUD insertion using conscious sedation. Conscious sedation included nitrous gas (termed “light” sedation) or intravenous midazolam and fentanyl (termed “moderate” sedation). Patient demographics, medical and gynecological histories were analyzed. ResultsThere were 69 attempted IUDs insertions during the study period. Most (75.36%) were placed under light sedation, and 92.75% were successfully inserted. The only significant factor associated with choice in type of conscious sedation was prior sexual activity, which increased odds by 10.0 that they would choose light sedation (95% CI 1.23 – 81.34, p=0.031). Differences between other factors (age, history of sexual assault, tampon use, and gender identity) were not statistically significant between successful and failed insertions. ConclusionsIn conclusion, a history of sexual activity significantly differed between patients in our cohort who selected light sedation over moderate sedation. No other factors influenced choice in sedative or success of IUD insertion. Knowing the characteristics of patients who choose nitrous versus IV sedation, and how it relates to successful insertion, may help guide pre-procedural counseling for patients regarding sedation for IUD insertion.

A randomized clinical trial comparing the efficacy of lidocaine administered intravenously, intranasally or as infraorbital nerve block in dogs undergoing rostral rhinosocopy

ObjectiveTo compare the efficacy of lidocaine administered intravenously, intranasally or as an infraorbital nerve block in dogs undergoing rostral rhinoscopy. Study designRandomized clinical trial. AnimalsA total of 43 client-owned dogs. MethodsAfter premedication with medetomidine 0.01 mg kg–1 and methadone 0.2 mg kg–1 intramuscularly, anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Dogs were randomly allocated to receive 2 mg kg–1 of 2% lidocaine as a bilateral infraorbital nerve block (INB) via the caudal intraoral approach, via bilateral topical intranasal administration (TIA) or as an intravenous bolus (IVB). At 5 minutes following lidocaine administration, responses to rhinoscopy (RR) and biopsies (RB) were evaluated using a simple scoring system (0: no reaction; 1: reaction). Response to the rhinoscopy in the recovery period (RE) was recorded. Recovery quality was scored using a simple descriptive score. Heart rate, respiratory rate and noninvasive arterial blood pressure were recorded. Intravenous (IV) fentanyl 0.001 mg kg-1 was administered if an increase > 20% in any variable occurred. Gross movement was attenuated using propofol 0.5 mg kg–1 IV. Scores were analysed using the Chi-square test with Monte Carlo method. Cardiorespiratory changes among and overtime between groups were compared using one-way anova and one-way anova for repeated measures, respectively, or the correspondent non-parametric tests; p < 0.05. ResultOf the 43 dogs, 42 completed the study. No statistically significant differences were detected in either physical reactions or changes in cardiorespiratory variables for RR, RB, RE or recovery quality, although RB tended to be higher in group TIA (7/10 versus 1/10 INB and 3/13 IVB).Various cardiorespiratory variables changed overtime within groups. Conclusions and clinical relevanceIn dogs, all three investigated techniques attenuated responses during rostral rhinoscopy in dogs, although INB and IVB were more efficacious when biopsies were taken.

Effect of an intravenous acetaminophen/ibuprofen fixed-dose combination on postoperative opioid consumption and pain after video-assisted thoracic surgery: a double-blind randomized controlled trial

BackgroundVideo-assisted thoracoscopic surgery (VATS) often induces significant postoperative pain, potentially leading to chronic pain and decreased quality of life. This study aimed to evaluate the acetaminophen/ibuprofen combination effectiveness in reducing analgesic requirements and pain intensity in patients undergoing VATS.Study designThis is a double-blinded randomized controlled trial.MethodsAdult patients scheduled for elective VATS for lung resection were randomized to receive either intravenous acetaminophen and ibuprofen (intervention group) or 100 mL normal saline (control group). Treatments were administered post-anesthesia induction and every 6 h for three cycles. The primary outcome was total analgesic consumption at 24 h postoperatively. Secondary outcomes were cumulative analgesic consumption at 2 and 48 h; analgesic-related side effects at 2, 24, and 48 h; quality of recovery at 24 h and 48 h postoperatively; pain intensity at rest and during coughing; and rescue analgesics use. Chronic postsurgical pain (CPSP) was assessed through telephone interviews 3 months postoperatively.ResultsThe study included 96 participants. The intervention group showed significantly lower analgesic consumption at 24 h and 48 h postoperatively (24 h: median difference: − 100 µg equivalent intravenous fentanyl [95% confidence interval (CI) − 200 to − 5 μg], P = 0.037; 48 h: median difference: − 140 μg [95% CI − 320 to − 20 μg], P = 0.035). Compared to the controls, the intervention group exhibited a significantly lower quality of recovery 24 h post-surgery, with no significant difference at 48 h. All pain scores except for coughing at 48 h post-surgery were significantly lower in the intervention group compared to the controls. No significant differences were observed between the groups in postoperative nausea and vomiting occurrence, hospital stay length, and CPSP.ConclusionPerioperative administration of acetaminophen/ibuprofen significantly decreased analgesic needs in patients undergoing VATS, providing an effective postoperative pain management strategy, and potentially minimizing the need for stronger analgesics.

Effect of age on the median effective dose and 95% effective dose of intravenous fentanyl for blunting the hemodynamic response to tracheal intubation: A double-blind, up-and-down sequential method trial

Abstract Background and Aims: Control of the hemodynamic response during intubation is essential. To assess the effect of age on the median effective dose (ED50) and 95% effective dose (ED95) of fentanyl for blunting the hemodynamic response to intubation. Material and Methods: Patients (n = 86) undergoing general anesthesia were randomly stratified according to age (groups 1–4); fentanyl was administered to each patient according to the Dixon and Massey method, starting at 2 μg/kg. The dose was increased or decreased by 0.5 μg/kg for the subsequent patient, depending on the failure or success of blunting of the hemodynamic response, respectively. Success was defined as a change in heart rate and blood pressure by &lt;20% below the baseline at 1, 3, and 5 min after intubation. ED50 and ED95 were analyzed using R statistical software. Results: ED50s of fentanyl in groups 1 (20–35 years), 2 (36–50 years), 3 (51–65 years), and 4 (66–80 years) were 2 μg/kg (90% confidence interval, 1.50–2.50), 2.25 μg/kg (2.00–2.50), 1.89 μg/kg (1.54–2.21), and 1.27 μg/kg (0.72–1.82), respectively. ED95s in groups 1, 2, 3, and 4 were 2.45 μg/kg (2.32–2.96), 2.79 μg/kg (2.58–4.38), 2.44 μg/kg (2.33–3.06), and 2.70 μg/kg (2.30–5.18), respectively. There was a statistically significant incidence of cough in group 2. Conclusions: Patients aged 65–80 years required the lowest ED50 of fentanyl dose, whereas patients aged 36–50 years required the highest ED50 and ED95 dose to blunt the hemodynamic response during intubation.

Differential impact of fentanyl and morphine doses on ticagrelor-induced platelet inhibition in ST-segment elevation myocardial infarction: a subgroup analysis from the PERSEUS randomized trial.

Among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), intravenous fentanyl does not enhance ticagrelor-induced platelet inhibition within 2 h compared to morphine. The impact of the total dose of fentanyl and morphine received on ticagrelor pharmacodynamic and pharmacokinetic responses in patients with STEMI remains however undetermined. We performed a post-hoc subanalysis of the prospective, open-label, single-center, randomized PERSEUS trial (NCT02531165) that compared treatment with intravenous fentanyl vs. morphine among symptomatic patients with STEMI treated with primary PCI after ticagrelor pretreatment. Patients from the same population as PERSEUS were further stratified according to the total dose of intravenous opioids received. The primary outcome was platelet reactivity using P2Y12 reaction units (PRU) at 2 h following administration of a loading dose (LD) of ticagrelor. Secondary outcomes were platelet reactivity and peak plasma levels of ticagrelor and AR-C124910XX, its active metabolite, at up to 12 h after ticagrelor LD administration. Generalized linear models for repeated measures were built to determine the relationship between raw and weight-weighted doses of fentanyl and morphine. 38 patients with STEMI were included between December 18, 2015, and June 22, 2017. Baseline clinical and procedural characteristics were similar between low- and high-dose opioid subgroups. At 2 h, there was a significant correlation between PRU and both raw [regression coefficient (B), 0.51; 95% confidence interval (CI), 0.02-0.99; p = 0.043] and weight-weighted (B, 0.54; 95% CI, 0.49-0.59; p < 0.001) doses of fentanyl, but not morphine. Median PRU at 2 h was significantly lower in patients receiving low, as compared to high, doses of fentanyl [147; interquartile range (IQR), 63-202; vs. 255; IQR, 183-274; p = 0.028], whereas no significant difference was found in those receiving morphine (217; IQR, 165-266; vs. 237; IQR, 165-269; p = 0.09). At 2 h, weight-weighted doses of fentanyl and morphine were significantly correlated to plasma levels of ticagrelor and AR-C124910XX. In symptomatic patients with STEMI who underwent primary PCI after ticagrelor pretreatment and who received intravenous opioids, we found a dose-dependent relationship between the administration of intravenous fentanyl, but not morphine, and ticagrelor-induced platelet inhibition.

Evaluating Sedation Strategies for Magnetic Resonance Imaging: A Comprehensive Review of Intravenous Fentanyl, Butorphanol, and Midazolam in Adult and Pediatric Populations.

Magnetic resonance imaging (MRI) is a critical diagnostic tool that often requires patient sedation to ensure optimal image quality and patient comfort, particularly in those with anxiety or an inability to remain still. This comprehensive review examines the efficacy, safety, and practical considerations of three commonly used intravenous sedatives, namely, fentanyl, butorphanol, and midazolam, in adult populations undergoing MRI procedures. This review highlights the pharmacological profiles, advantages, and limitations associated with each sedative agent through a detailed analysis of current literature, clinical guidelines, and practice-based evidence. Fentanyl is noted for its potent analgesic properties and rapid onset of action, making it suitable for painful procedures. Butorphanol, with its unique opioid agonist-antagonist activity, presents an alternative with a balance between analgesia and sedation, potentially offering a safer profile for certain patient populations. Midazolam, widely recognized for its anxiolytic and amnestic effects, remains a staple in managing procedure-related anxiety. The review further discusses patient selection criteria, dosing strategies, and the importance of individualized sedation planning to enhance patient experience and procedural outcomes. Future directions highlight the potential of emerging sedation agents and non-pharmacological approaches to improve patient comfort and compliance. The findings underscore the necessity for healthcare providers to adapt sedation practices to the specific needs of each patient, considering both the clinical context and the inherent characteristics of the sedative agents. This review aims to guide clinicians in selecting the most appropriate sedation strategy for adult patients undergoing MRI, optimizing patient care and diagnostic efficacy.

Xylazine suppresses fentanyl consumption during self-administration and induces a unique sex-specific withdrawal syndrome that is not altered by naloxone in rats.

Prescription and illicit opioid use are a public health crisis, with the landscape shifting to fentanyl use. Since fentanyl is 100-fold more potent than morphine, its use is associated with a higher risk of fatal overdose that can be remediated through naloxone (Narcan) administration. However, recent reports indicate that xylazine, an anesthetic, is increasingly detected in accidental fentanyl overdose deaths. Anecdotal reports suggest that xylazine may prolong the fentanyl "high," alter the onset of fentanyl withdrawal, and increase resistance to naloxone-induced reversal of overdose. To date, no preclinical studies have evaluated the impacts of xylazine on fentanyl self-administration (SA; 2.5 μg/kg/infusion) or withdrawal to our knowledge. We established a rat model of xylazine/fentanyl co-SA and withdrawal and evaluated outcomes as a function of biological sex. When administered alone, chronic xylazine (2.5 mg/kg, intraperitoneal) induced unique sex-specific withdrawal symptomatology, whereby females showed delayed onset of signs and a possible enhancement of sensitivity to the motor-suppressing effects of xylazine. Xylazine reduced fentanyl consumption in both male and female rats regardless of whether it was experimenter-administered or added to the intravenous fentanyl product (0.05, 0.10, and 0.5 mg/kg/infusion) when compared to fentanyl SA alone. Interestingly, this effect was dose-dependent when self-administered intravenously. Naloxone (0.1 mg/kg, subcutaneous injection) did not increase somatic signs of fentanyl withdrawal, regardless of the inclusion of xylazine in the fentanyl infusion in either sex; however, somatic signs of withdrawal were higher across time points in females after xylazine/fentanyl co-SA regardless of naloxone exposure as compared to females following fentanyl SA alone. Together, these results indicate that xylazine/fentanyl co-SA dose-dependently suppressed fentanyl intake in both sexes and induced a unique withdrawal syndrome in females that was not altered by acute naloxone treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Influence of intravenous fentanyl or dexmedetomidine infusions, combined with lidocaine and ketamine, on cardiovascular response, sevoflurane requirement and postoperative pain in dogs anesthetized for unilateral mastectomy

ObjectiveTo compare the effects of constant rate infusions (CRI) of fentanyl or dexmedetomidine, combined with lidocaine and ketamine, on cardiovascular response during surgery, sevoflurane requirement and postoperative pain in dogs undergoing mastectomy. Study designProspective, randomized, blinded, clinical trial. AnimalsA total of 29 female dogs with mammary tumors. MethodsPremedication consisted of intramuscular acepromazine and morphine. General anesthesia was induced with intravenous propofol and maintained with sevoflurane. Dogs were randomized to be administered intravenous DLK [dexmedetomidine 1 μg kg–1 loading dose (LD) and 1 μg kg–1 hour–1; lidocaine 2 mg kg–1 LD and 3 mg kg–1 hour–1; ketamine 1 mg kg–1 LD and 0.6 mg kg–1 hour–1; n = 14] or FLK (fentanyl 5 μg kg–1 LD and 9 μg kg–1 hour–1; same doses of lidocaine and ketamine; n = 15) during anesthesia. Cardiorespiratory variables and end-tidal sevoflurane (Fe′Sevo) were recorded during surgery. The number of dogs administered ephedrine to treat arterial hypotension [mean arterial pressure (MAP) < 60 mmHg] was recorded. Meloxicam was administered to both groups. Postoperative pain and rescue analgesia requirement were assessed for 24 hours using the short form of the Glasgow Composite Measure Pain Scale. Data were compared using a mixed effects model or a Mann–Whitney test. ResultsMore dogs required ephedrine in FLK than in DLK (67% versus 7%). Heart rate was not significantly different between groups, whereas lower values of MAP (p ≤ 0.01) and Fe′Sevo (p = 0.018) were observed in FLK than in DLK. Rescue analgesia was administered to 2/15 dogs in FLK and 0/14 dogs in DLK. Conclusions and clinical relevanceBased on the cardiovascular response during surgery, intraoperative infusions of FLK and DLK provided adequate antinociception. Infusion of DLK provided greater stability of blood pressure. Both protocols resulted in minimal need for additional analgesia within 24 hours postoperatively.

Gastrointestinal adverse effects associated with the use of intravenous oliceridine compared with intravenous hydromorphone or fentanyl in acute pain management utilizing adjusted indirect treatment comparison methods.

Background: In the absence of head-to-head comparative data from randomized controlled trials, indirect treatment comparisons (ITCs) may be used to compare the relative effects of treatments versus a common comparator (either placebo or active treatment). For acute pain management, the effects of oliceridine have been compared in clinical trials to morphine but not to fentanyl or hydromorphone. Aim: To assess the comparative safety (specifically differences in the incidence of nausea, vomiting and opioid-induced respiratory depression [OIRD]) between oliceridine and relevant comparators (fentanyl and hydromorphone) through ITC analysis. Methods: A systematic literature review identified randomized clinical trials with oliceridine versus morphine and morphine versus fentanyl or hydromorphone. The ITC utilized the common active comparator, morphine, for the analysis. Results: A total of six randomized controlled trials(oliceridine - 2; hydromorphone - 3; fentanyl - 1) were identified for data to be used in the ITC analyses. The oliceridine data were reported in two studies (plastic surgery and orthopedic surgery) and were also reported in a pooled analysis. The ITC focused on nausea and vomiting due to limited data for OIRD. When oliceridine was compared with hydromorphone in the ITC analysis, oliceridine significantly reduced the incidence of nausea and/or vomiting requiring antiemetics compared with hydromorphone (both orthopedic surgery and pooled data), while results in plastic surgery were not statistically significant. When oliceridine was compared with hydromorphone utilizing data from Hong, the ITC only showed a trend toward reduced risk of nausea and vomiting with oliceridine that was not statistically significant across all three comparisons (orthopedic surgery, plastic surgery and combined). An ITC comparing oliceridine with a study of fentanyl utilizing the oliceridine orthopedic surgery data and combined orthopedic and plastic surgery data showed a trend toward reduced risk that was not statistically significant. Conclusion: In ITC analyses, oliceridine significantly reduced the incidence of nausea and/or vomiting or the need for antiemetics in orthopedic surgery compared with hydromorphone and a non-significant trend toward reduced risk versus fentanyl.

COMPARISON OF THE EFFECTIVENESS AND SAFETY BETWEEN INTRAVENOUS DEXMEDETOMIDINE WITH FENTANYL VERSUS INTRAVENOUS PROPOFOL WITH FENTANYL FOR SEDATION IN DIAGNOSTIC UPPER GASTROINTESTINAL ENDOSCOPY

Objective: The aim of this study was to compare the effectiveness and safety of intravenous dexmedetomidine with fentanyl versus intravenous propofol with fentanyl for sedation in diagnostic upper gastrointestinal (GI) endoscopy. Methods: 50 patients of ASA grade I, II, or III scheduled for GI endoscopy were randomly divided into two groups of 25 patients each. Group D received intravenous fentanyl and intravenous dexmedetomidine, and Group P received intravenous fentanyl and intravenous propofol. Hemodynamic variables, level of sedation using the Ramsay sedation score (RSS), patient satisfaction, and surgeon satisfaction using the visual analog scale (VAS) were recorded. Results: There was no significant difference in the demographic parameters (age, gender, weight, ASA class) between the two groups. The mean time to reach RSS 4–5 was less in group P (27.60±6.44 s) when compared to group D (521.56±39.13 sec; p=0.0004). Patient satisfaction was higher in group D (7.9±0.7) as compared to group P (7.3±0.8; p=0.0069). While there was no significant difference in the surgeon’s satisfaction regarding difficulty during the procedure (8.3±0.9 and 7.9±1.3 in group D and group P, respectively; p=0.2120). Conclusion: Dexmedetomidine with fentanyl resulted in a better hemodynamic profile, respiratory profile, patient satisfaction, and quicker recovery than propofol with fentanyl. Whereas propofol with fentanyl provided quicker onset and more efficient sedation compared to dexmedetomidine with fentanyl.

Subcutaneous vs intravenous fentanyl for labor pain management: a multicenter randomized controlled trial

Labor pain is the most intense pain a woman will experience during her lifetime. Epidural anesthesia is recommended as the most effective method for pain relief, but it has several limitations. Fentanyl has high analgesic potency with short-acting duration, but the large-scale trials that assessed the effectiveness and safety of it for labor pain management are still limited. This study aimed to compare the effectiveness and harm and maternal satisfaction of subcutaneous vs intravenous fentanyl for labor pain management. We conducted a multicenter, open-label randomized controlled trial. A total of 226 women were randomized to receive intravenous or subcutaneous fentanyl for labor pain management. Pain scores were evaluated before and after fentanyl administration at 5, 30, and 60 minutes and then every 60 minutes until delivery. The data were analyzed based on the intention-to-treat principle. Both intravenous and subcutaneous fentanyl significantly decreased labor pain from baseline to delivery (overall mean change, -1.39; 95% confidence interval, -1.62 to -1.17; and -0.89; 95% confidence interval, -1.24 to -0.05, respectively). The reduction in the pain score between the 2 groups was not different (overall mean difference, -0.35; 95% confidence interval, -0.76 to 0.05). Maternal satisfaction was high for both intravenous and subcutaneous fentanyl (89.4% and 93.8%, respectively). There was no difference in the maternal satisfaction rate between the 2 groups (relative risk, 0.95; 95% confidence interval, 0.88-1.03). No serious maternal and neonatal adverse effects were observed. Both intravenously and subcutaneously administered fentanyl were safe and significantly reduced pain from baseline to delivery among low-risk pregnancies. Maternal satisfaction with the childbirth experience was high regardless of the route of administration of fentanyl. No serious adverse effects of fentanyl were observed in either the mothers or the neonates.

Neuroanesthesia Management in Transspenoidal Pituitary Cyst Surgery

Background: Neuroanesthesia management of patients with masses in the sella area undergoing transspenoidal surgery is a challenge for anesthesiologists. Good preoperative, intraoperative and postoperative management is shown to improve the patient’s quality of life. Case: A 45-year-old man with chief complaints of headache and visual disturbances, from the results of the vision examination obtained visus 1/60 (count fingers) and narrowed visual field area. From computerized tomography (CT) scan and Magnetic resonance imaging (MRI) images of the Head obtained a picture of cystic mass of the suprasellar sella pressing the optic chiasm. The patient was planned for surgical excision of pituitary cyst per transspenoidal. The patient underwent general anesthesia with endotracheal intubation with intravenous induction fentanyl, propofol, atracurium and lidocaine, followed by maintenance with sevoflurane inhalation agent with 60% oxygen. During the operation the hemodynamic condition was stable and postoperatively the patient was extubated in the operating room and then treated in the intensive care unit. Conclusion: In pituitary cyst patients undergoing transspenoidal surgery, the preoperative evaluation is mainly aimed at airway assessment, neurological disorders and hormonal disorders in patients. During intraoperative, the anesthesiologist is expected to optimize cerebral oxygenation, maintain hemodynamic stability, facilitate the surgical area, prevent and manage intraoperative complications and rapid recovery of consciousness. Postoperatively a good neuroendocrine evaluation is required

Comparison of intravenous ketamine and fentanyl sedation in duration of mechanical ventilation in intensive care unit

Background and aims: To compare the duration of mechanical ventilation in patients receiving ketamine compared to fentanyl for sedation in mechanically ventilated patients in intensive care unit. Methods: One hundred and six patients requiring mechanical ventilation were randomized to receive continuous intravenous infusion of either ketamine (1 mg/kg bolus followed by 0.4 to 0.8 mg/kg/h) or fentanyl (1mcg/kg bolus followed by 0.3-0.5 mcg/kg/min) with the dose titrated to achieve Richmond Agitation Sedation Scale (RASS) score of 0 to -1 and Behavioral Pain Scale (BPS) score of 3 to 7. The primary outcome was the duration of mechanical ventilation. Secondary outcomes were sedation score, analgesia score and need of vasopressors. Results: The mean duration of ventilation was 2.5±0.6 days and 2.2±1.0 days (p=0.1) in patients receiving ketamine and fentanyl respectively. More patients required vasopressors: 27 (50.9%) vs 9 (17%) in patients receiving fentanyl compared to ketamine (p&lt;0.05). There were no significant changes in hemodynamic variables after the initiation of the study drug in both the groups. Infusion was discontinued for adverse effects in seven (13%) patients in both the groups. Conclusion: When compared with fentanyl, continuous ketamine infusion was tolerated similarly by critically ill adults, with similar duration of mechanical ventilation. Ketamine sedation was associated with decreased requirement for vasopressors.

A Rare Case of Perioperative Methemoglobinemia in a Paediatric Child: A Case Report

Methemoglobinemia is a rare condition that caused impairment of oxygen delivery manifested as spectrum of features ranging from mild desaturations to severe cyanosis and even death. It is rarely seen in the operative theatre and its incidence is scarcely reported. Even low risk patients are susceptible despite having no significant exposure to commonly reported precipitating oxidizing agents. We described a case of perioperative methemoglobinemia in a 10-year-old child, which was planned for foreign body removal in left ear. The operation went successfully; however, the child developed desaturation postoperatively. Arterial blood gas was measured, and methemoglobin levels were noticeably high at 27.1%. The child remained hemodynamically stable, monitored conservatively, and was successfully treated with intravenous methylene blue. We postulated that the cause of methemoglobinemia was intravenous fentanyl usage, as other oxidising agents were excluded. Clinicians must be aware of the possibility of perioperative methemoglobinemia causing unanticipated desaturations and unexplained cyanosis.

Ultrasound-guided suprainguinal fascia iliaca block to position the patient for neuraxial anaesthesia in acetabular surgery - a randomized controlled pilot study.

Neuraxial anaesthesia is a common choice for most hip and lower limb operations. Pain associated with positioning is often a deterrent, and the vast literature suggests different regional blocks and opioids for these patients. Patients with acetabular fractures may experience increased pain, and thus are more difficult to position for the neuraxial block. We conducted a randomized controlled pilot study to assess and compare the analgesic efficacy of ultrasound-guided suprainguinal fascia iliaca block (SFICB) versus systemic fentanyl to facilitate positioning for combined spinal epidural (CSE) anaesthesia in patients undergoing acetabular fracture surgery. Twenty patients referred for surgical repair of acetabular fractures were randomly assigned to receive either ultrasound-guided SFICB (group B) or intravenous fentanyl (group F). Changes in visual analogue scale (VAS) scores in supine and sitting position, improvement in sitting angle (SA), positioning quality, rescue analgesic requirement, total opioid consumption, comfort VAS scores, and complications were noted to compare both groups. The post-intervention VAS score in the sitting position was significantly lower in group B than in group F (5.9 ± 2.1 vs. 3.5 ± 1.5, P = 0.01). Group B also had more significant improvement in SA (27.5° (20.75-36.5°), in comparison to group F (10 (5-18.75), P = 0.006). The positioning quality was better in group B, with 70% of patients achieving an optimal position compared to only 10% in group F ( P = 0.02). Ultrasound-guided SFICB, as compared to systemic fentanyl, provided better analgesia and helped to achieve a better and more comfortable position to perform the neuraxial block.

Perfusion index as a predictor of hypotension following induction of general anaesthesia with propofol-An observational study

Background: Perfusion index (PI) is a somewhat novel parameter evaluating the pulsatility of blood in the extremities, calculated using the infrared spectrum as a component of plethysmography waveform processing. Aims and Objectives: To obtain a cutoff value of pre-anesthesia PI, which may be helpful for the prediction of hypotension following anesthetic induction with propofol. Materials and Methods: This descriptive observational research was carried out at the Sree Gokulam medical college and research foundation, Venjaramoodu, Trivandrum, Kerala, from June 2020 to June 2021. A total of 174 patients of age group 17–60 years, with ASA 1 or 2 scheduled for surgery under general anesthesia, were included. The parameters (systolic blood pressure [SBP], diastolic blood pressure, mean arterial pressure, PI, and SPO2) were recorded until 5 min of induction. Intravenous (IV) fentanyl 2 μg/kg was administered, propofol injected was given slowly at a rate of 10 mg per every 5 s, titrated to loss of verbal communication responseuronium 0.1 mg/kg IV was administered. The calculation for hypertension was done 5 min after anesthesia. The predictive validity of PI was calculated, keeping SBP as the standard gold test. For statistical analysis coGuide software. Results: The cutoff value for PI at 5 min was low (≤2.45) for 27 (90%) participants and high (&gt;2.45) for 3 (10%) participants. With a sensitivity of 90% in predicting hypotension and specificity of 87.50%, false-positive rate was 12.50%, false-negative rate was 10, positive predictive value was 60% (95 CI 44.43–74.30%), the negative predictive value (NPV) was 97.67%, and the total diagnostic accuracy was 87.93%. Conclusion: With the current study’s findings, we conclude that PI cutoff value 2.45 can be used to predict hypotension following anesthetic induction with propofol. It has a high NPV with fair diagnostic accuracy.

A Case of True Allergy to Amide Local Anesthetics in a Parturient

IgE-mediated hypersensitivity reactions to amide local anesthetics (LAs) are very rare events in anesthesia practice. When such a reaction occurs, anesthesiologists are often left with numerous confounding causes of adverse e after LA administration. Most times, such reactions result from systemic toxicity or non-hypersensitivity reactions. In the event of a true allergy to LA molecules, subsequent administration of the same drug can lead to life-threatening complications. Herewith, we report the successful diagnosis of LA allergy in a parturient who had a history of anaphylaxis following the administration of subarachnoid block with an unknown drug elsewhere. She presented to our institute for her second cesarean section. Skin prick testing was done after a dermatology consultation, which revealed a positive response to lignocaine, bupivacaine, and ropivacaine (preservative-free). She was taken up for elective cesarean section under general anesthesia with complete avoidance of LAs. Postoperative analgesia was instituted with intravenous patient-controlled fentanyl administration. The procedure and recovery were uneventful and both mother and baby were discharged without any issues.