Ml Of Fentanyl Research Articles

Effects of a fentanyl-propofol mixture on propofol injection pain: a randomized clinical trial.

BackgroundPropofol injection pain is a common problem that can be very distressing for patients. We compared the effects of injection with saline followed by injection with a fentanyl-propofol mixture, injection with fentanyl followed by a propofol injection, and injection with saline followed by propofol alone on propofol injection pain.MethodsThe patients were assigned randomly to one of three groups. A rubber tourniquet was placed on the forearm to produce venous occlusion for 1 min. Before anesthesia induction, group C (control, n = 50) and group M (fentanylpropofol mixture, n = 50) received 5 ml of isotonic saline, while group F (fentanyl, n = 50) received 2 µg/kg of fentanyl. After the tourniquet was released, groups C and F received 5 ml of propofol and group M received 5 ml of a mixture containing 20 ml of propofol and 4 ml of fentanyl. At 10 s after the study drugs were given, a standard question about the comfort of the injection was asked of the patient. We used a verbal rating scale to evaluate propofol injection pain. Statistical analyses were performed with Student's t-tests and Fisher's exact tests; P < 0.05 was considered to indicate statistical significance.ResultsThe demographic data were similar among the groups. In group M, the number of patients reporting propofol injection pain was significantly lower than in groups F and C (both P < 0.001). No patient in group F or M experienced severe pain, whereas 24 patients (48%) had severe pain in group C (both P < 0.001).ConclusionsThis study shows that a fentanyl-propofol mixture was more effective than fentanyl pretreatment or a placebo in preventing propofol injection pain.

Intraoperative, rapid administration of high-dose fentanyl by a dysfunctioning plunger lock of a syringe pump; the siphon effect

Syringe pumps are designed to deliver drugs in a safe manner, however, these devices can be potentially dangerous if operated improperly. A 50-year-old male was scheduled to undergo an elective liver transplantation. After induction of anesthesia, the Baxter AS40A pump was loaded with a 50 ml Becton Dickinson syringe containing 2,500 µg of fentanyl. Continuous infusion at 5 ml/hr was started without knowing that part of the plunger lock, i.e. the upper plunger clamp assembly, was damaged (Fig. 1), and, therefore, the plunger was incompletely clamped without notice. Ten minutes later the patient experienced marked sinus bradycardia and hypotension for which a rescue drug of 10 µg of epinephrine was injected twice. Surprisingly, the syringe loaded on AS40A was found to be empty and the missing 50 ml of fentanyl was concluded to have been infused rapidly into the patient. However, even at this point there was no alarm signal or error message to indicate a dysfunctional plunger clamp. Fig. 1 A Baxter AS40A pump with a normal (A) and damaged (B) plunger clamp assembly which dose not firmly hold the plunger. Of many possible reasons, a siphon effect was strongly suspected to be the cause of this mishap, which refers to the continuous flow of liquids through enclosed conduit by the force of gravity once it had been initiated, because we can acknowledge that a complete spillage of 50 ml syringe volume occurred within five minutes when the plunger lock was unclamped and manually started. Although high-dose fentanyl administration has been seen to be hemodynamically stable [1], such as in this case, bolus administration of another drug such as dopamine or norepinephrine, which is usually delivered using a Baxter infusion pump, may have catastrophic effects. Although a newer version of the Baxter AS40A pump has an alarm sensor for the syringe plunger lock, understanding the specifics of commonly used, older equipment in the operating room is crucial [2], and meticulous attention to a possibly improperly secured plunger head is always warranted in order to avoid potentially adverse outcomes.

Analgesia in post-thoracotomy patients: Comparison between thoracic epidural and thoracic paravertebral blocks.

Background:Acute postoperative pain can cause detrimental effects on multiple organ systems, leading to chronic pain syndromes.Objective:To compare thoracic epidural block (TEB) and paravertebral block (PVB) for relief of postoperative pain in adult patients undergoing thoracotomy.Materials and Methods:In this randomized, single-blinded, prospective study, 60 adult patients of both sexes, belonging to ASA physical status I and II, were scheduled for elective thoracotomy under general anesthesia. They were randomly divided into two groups, A and B of 30 each, who were comparable in terms of demographic parameters and body weight. Group A received TEB and Group B received PVB. All the patients underwent thoracotomy under general anesthesia using a uniform standard anesthetic technique. Thirty minutes before the anticipated end of skin suture, blocks were activated in both the groups with 7.5 ml for TEB and 15 ml for thoracic PVB of 0.25% bupivacaine, along with 1 ml of fentanyl for postoperative analgesia.Results:Patients receiving PVB for postoperative analgesia experienced better analgesia than those receiving TEB from the immediate postoperative period that lasted longer. Intragroup comparison showed that in the cases receiving TEB, there was a significant statistical difference in preoperative and postoperative values with regard to the mean systolic blood pressure (SBP), mean arterial pressure and mean pulse rate. However, in patients receiving PVB, significant difference in preoperative and postoperative values was seen in mean SBP only.Conclusions:We observed longer duration of analgesia with PVB compared to TEB.

Comparison of forced expiratory spirometric flow changes following intrathecal bupivacaine and bupivacaine with fentanyl

ABSTRACTBackground: Higher dermatomal block following spinal anaesthesia impairs inspiratory capacity and decreases forced expiratory flow rates. This decrease in forced expiratory flows can in turn decrease the effectiveness of cough. Intrathecal opioids are important adjuncts to intrathecal local anaesthetics. The objective of our study was to compare the decrease in forced expiratory flows from the baseline values after subarachnoid block with bupivacaine and bupivacaine with fentanyl.Methods: Institutional ethics committee approval was obtained. Forty ASA I and II adult males, scheduled for elective surgery were included in the study. Informed written consent was obtained from all patients who were randomly allocated into two groups. Group B received intrathecal anaesthesia 15 mgs of bupivacaine with 0.5 ml of normal saline and Group BF received 15 mgs of bupivacaine with 0.5 ml of fentanyl (25 μg) intrathecally. The patients were instructed about the performance of the spirometry on the previous even...

Spinal anaesthesia with a micro-catheter in high-risk patients undergoing colorectal cancer and other major abdominal surgery

Extended spinal anaesthesia using a spinal micro-catheter was used as a primary method of anaesthesia for elective colorectal cancer surgery in 68 high risk patients over a 14-year period in our institution. The technique was also useful in eight elective and 13 emergency abdominal surgeries. All patients suffered from severe chronic obstructive airway disease requiring multiple inhalers and drugs (ASA III). Thirty nine of these patients also suffered from angina, myocardial infarction, diabetes and other systemic diseases (ASA IV). Surgery included right hemicolectomy, left hemicolectomy, total colectomy, sigmoid colectomy, Hartman's resection, anterior resection of rectum, abdominoperineal resection, cholecystectomy (open and laparoscopic) and obstructed inguinal hernia requiring laparotomy. Spinal anaesthesia was performed under strict aseptic conditions with a 22 gauge spinal needle with a mixture consisting of 2.75ml of 0.5% heavy bupivacaine and 0.25ml of fentanyl (25microg). This was followed by placement of a spinal micro-catheter and the duration of anaesthesia was extended by intermittent injection of 0.5% isobaric bupivacaine. Brief hypotension occurred in 12.4% of patients during the establishment of anaesthetic block height to T6-7 and was duly treated with intravenous administration of fluid and ephedrine hydrochloride. Good anaesthesia resulted in all patients except for brief discomfort in some patients during hemicolectomy surgery possibly due to the dissection and traction on the peritoneum causing irritation to the diaphragm. The use of sedation was avoided. General anaesthesia was administered in one patient and this patient required postoperative ventilation and cardiovascular support in the Intensive Care Unit. The spinal micro-catheter was removed at the end of surgery. Postoperative pain relief was obtained by administering intravenous morphine through a patient controlled analgesia machine in the critical care ward area (High Dependency Unit). There was a low incidence of minor postoperative side effects such as nausea (14.6%), vomiting (7.9%), minor post dural puncture headache (5.6%) and pruritus (5.6%). We conclude that spinal anaesthesia with a micro-catheter may be used as a primary method of anaesthesia for colorectal cancer surgery and other major abdominal surgery in high-risk patients for whom general anaesthesia would be associated with higher morbidity and mortality.

MTP8-01: Percutaneous radiofrequency ablation of malignant thoracic tumors

MTP8-01: Percutaneous radiofrequency ablation of malignant thoracic tumors

What a Pain!

MN is a 40-year-old woman, 5=8 , 166 pounds, with a past medical history (PMH) of hypothyroidism. She takes Synthroid daily. She has never before had surgery, but underwent a laparoscopic cholecystectomy procedure that lasted 135 minutes because her gallbladder was partially gangrenous and significantly adherent to the surrounding tissue. MN had general anesthesia consisting of 3 mg of midazolam, 2 mL of fentanyl, and 100 mg propofol for induction, as well as oxygen, nitrous oxide, sevoflurane, and atracurium that was reversed with neostigmine and atropine completely at the end of the case. MN received 10 mg of morphine titrated over the final hour of the procedure. She was intubated and extubated without incident and arrives in the PACU very restless and complaining of severe abdominal pain.

The effect of intrathecal fentanyl added to hyperbaric bupivacaine on maternal respiratory function during Cesarean section

Subarachnoid blockade with local anesthetics induces respiratory depression. Although the addition of fentanyl to bupivacaine has become popular in subarachnoid blockade for Cesarean section, there is no information on the effect of intrathecal fentanyl on maternal spirometric respiratory function in parturients undergoing Cesarean section. We tested the effect of the addition of intrathecal fentanyl to hyperbaric bupivacaine on maternal spirometric performance in 40 consenting parturients undergoing Cesarean section. The parturients were randomized into two groups: those receiving 2.0 ml of hyperbaric bupivacaine 0.5% and 0.4 ml of saline intrathecally and those receiving 2.0 ml of hyperbaric bupivacaine and 0.4 ml of fentanyl (20 microg) intrathecally. We performed spirometry on arriving at the operation room and 15 min after subarachnoid blockade. Subarachnoid blockade with bupivacaine significantly decreased the peak expiratory flow rate, but did not induce significant changes in vital capacity and forced vital capacity. The addition of intrathecal fentanyl to bupivacaine improved the quality of subarachnoid blockade, but did not lead to a deterioration in respiratory function compared with intrathecal bupivacaine alone. The addition of intrathecal fentanyl to hyperbaric bupivacaine did not lead to a deterioration in maternal spirometric respiratory function in parturients undergoing Cesarean section.

Is Miscarriage a Risk Factor for Postdural Puncture Headache?

To the Editor: At our institution, the incidence of postdural puncture headache (PDPH) associated with spinal anesthesia for cesarean section is less than 1% (using Whitacre 25-gauge spinal needles, 1.6 mL of hyperbaric bupivacaine, and 0.2 mL of fentanyl). When postpartum tubal ligation is performed 1 day postoperatively, the incidence of PDPH is less than 2% (with an open laparotomy and spinal anesthesia using a Whitacre 25-gauge spinal needle and 60 mg of hyperbaric lidocaine with 0.2 mL of fentanyl). By contrast, our 2-year retrospective data on the use of spinal anesthesia for dilation and curretage after miscarriage (<18 wk gestation) resulted in a PDPH incidence of 8%. This is with the same 25-gauge Whitacre spinal needles, the same practitioners, and routine use of hyperbaric lidocaine (usually without fentanyl). Most of these headaches have required an epidural blood patch. Naulty et al. [1] suggested an increased incidence of PDPH with hyperbaric lidocaine (versus bupivacaine or tetracaine). The addition of fentanyl may play a role in reducing the incidence of PDPH [2]. We wonder whether the physiology associated with miscarriage contributes to an increased incidence of PDPH. Mark D. Johnson, MD Mark Schlanger, DO Department of Anesthesia; Melrose-Wakefield Hospital; Melrose, MA 02176

Compatibility and stability of fentanyl admixtures in polypropylene syringes.

To determine the physicochemical stability of fentanyl in combination with midazolam and either hyoscine butylbromide or metoclopramide, and stored in 30 ml polypropylene syringes. Solutions containing approximately 40 microg/ ml of fentanyl in combination with midazolam (approximately 600 microg/ml) and either metoclopramide (approximately 700 microg/l) or hyoscine (approximately 850 microg/ml) were prepared from commercial ampoules of the drugs. The solutions were stored, in triplicate, in the dark at 32 degrees C (to simulate usage conditions) for 10 days, and the concentration of each constituent drug was periodically determined using a stability-indicating high-performance liquid chromatography assay. The combinations were relatively stable, with all drugs maintaining over 90% of their initial chemical potency for at least 1 week. There were no evident changes in either the physical appearance or pH values of the solutions over the course of the study. On the basis of physicochemical stability, polypropylene syringes containing fentanyl with midazolam and either hyoscine butylbromide or metoclopramide can be safely prepared and stored at or below 32 degrees C for periods of up to 1 week prior to use by palliative care patients receiving the drugs via a portable subcutaneous infusion device.

CAUDAL EPIDURAL REGIONAL ANESTHESIA AND ANALGESIA IN NEONATES WITH ABDOMINAL DEFECTS

INTRODUCTION: In this study we reviewed our experience with caudal epidural catheters in newborns with abdominal wall detects who were less than 48H (hours) of age. Methods: After receiving HSPC approval, charts of 5 former newborns who underwent abdominal wall defect (gastroschesis and omphaloccele) repair were reviewed. Either a 20 or 24g catheter was inserted 3-6cm into the epidural space, via the caudal route. After a test dose of lidocaine an infusion of 0.5-2.0% lidocaine with 1-2mcg/ml of fentanyl was begun. RESULTS: Results of the review are listed in Table 1. Five infants less than 48h of age weighing 1.92-2.70 kg had caudal epidural catheters placed easily. The catheters remained in situ for 3-20 days. No infections from the catheters occurred. Plasma lidocaine levels were <0.5-5.8 mcg/ml. Discussion: No adverse effects to the local anesthetic or opiate were observed. The use of epidural infusions in neonates with abdominal wall defects provides a useful alternative to the standard sedation and paralysis currently used at our institution.