Injection Of Sufentanil Research Articles

Intravenous lidocaine decreased oxygen-desaturation episodes induced by propofol-based sedation for gastrointestinal endoscopy procedures: a prospective, randomized, controlled trial

BackgroundAs a popularly used analgesic adjuvant, intravenous (IV) lidocaine could reduce the consumption of propofol in painless gastrointestinal (GI) endoscopy. However, whether IV lidocaine could affect the incidence of oxygen-desaturation episodes (ODE) during painless GI endoscopy is still unknown. Therefore, we tested the hypothesis that IV lidocaine could decrease the incidence of propofol-induced ODE and involuntary movements in patients during GI endoscopy.MethodsThree hundred twenty-two patients scheduled for GI endoscopy were randomly divided into lidocaine group and control group. After midazolam and sufentanil injection, a bolus of 1.5 mg/kg lidocaine was given and followed by continuous infusion of 4 mg/kg/h in lidocaine group, whereas the same volumes of saline solution in control group. Then, propofol was titrated to produce unconsciousness. The primary outcome was the incidence of ODE during the procedure. The secondary outcomes were the incidence of different degree of hypoxia and corresponding treatments and the involuntary body movements.ResultsA total of 300 patients were finally included in the analysis, 147 patients in lidocaine group and 153 in control group. The incidence of ODE was 22% in lidocaine group and 39% in control group (OR:0.052; 95%CI: 0.284–0.889; P = 0.018). IV lidocaine also improved the occurrence of different degree of hypoxia (P = 0.017) and needed few treatments (P = 0.028). The incidence of involuntary body movements (14% vs 26%, P = 0.013) and adverse circulatory events was decreased by IV lidocaine.ConclusionsIV lidocaine adjuvant to propofol-based sedation could reduce the incidence of oxygen-desaturation episodes and involuntary body movements, with fewer adverse circulatory events.Trial registrationChinese Clinical Trial Registry ChiCTR2100053818. Registered on 30 November 2021.

Comparison of the Clinical Effects of Ciprofol, Propofol, and Etomidate in the Combined Painless Gastroscopy and Enteroscopy: A Randomized Controlled Trial

<i>Background</i>: Propofol and etomidate are commonly used for sedation during painless gastroenteroscopy, but both have significant side effects. Cycline is a new sedative with minor side effects. This study aims to observe the clinical effects of ciprofol, propofol, and etomidate in the combined painless gastroscopy and enteroscopy. <i>Methods</i>: We randomly divided 600 outpatients aged 18-70 years, with a body mass index 18-30 kg/m<sup>2</sup>, and an ASA score of I-II, who underwent painless gastroenteroscopy, into three groups: propol group, etomidate group, and cyclizine group, with 200 cases in each group. All groups were pre-injected with 01 ug/kg sufentanil injection intravenously. The propofol group was given 2 mg/kg propofol injection intravenously, theomidate group was given 0.2 mg/kg etomidate injection intravenously, and the cyclizine group was given 0.4 mg cyclizine injection intravenously. The injection time for all groups was 30±5 seconds. The examination began when the MOAA/S score was 0-1 or the corneal reflex disappeared. 1. We observed the incidence of injection pain, onset time, sedation success rate, incidence of movement, incidence of respiratory depression, circulatory inhibition, awakening time, PACU time, and satisfaction of the examiner and the patient in all three groups; We observed the adverse reactions such as muscle pain and intraoperative awareness in the patients of all three groups. <i>Results</i>: 1. There were no differences in basic information of the patients in the three groups. The sedation success rate in all three groups was 100%. There were no significant differences in the time, awakening time, and PACU time among the three groups (P>0.05); 2. The incidence of injection pain, respiratory depression, circulatory inhibition in the propofol group was higher than that in the etomidate group and the cyclizine group, with significant differences (P<.05). However, there were no significant differences between the etomidate group and the cyclizine group. The satisfaction of the patients and the exam in the cyclizine group was higher (P<0.05); 3. Although there were no significant differences in the incidence of adverse reactions among three groups, the incidence of muscle tremor and muscle pain in the etomidate group was significantly higher than that in the propofol group and the cycline group, with significant differences (P<0.05). <i>Conclusion</i>: The clinical effect of ciprofol for painless gastroenteroscopy is significantly better than that of propofol and etomidate, and suitable for promotion in outpatient painless gastroenteroscopy.

The potency-ratio of ciprofol and propofol under procedural sedation and anesthesia for outpatient hysteroscopy during cervical dilation: a study using up-and-down sequential allocation method.

Ciprofol(HSK3486) is a novel 2,6-disubstituted phenol derivate, a short-acting intravenous sedative, which has similar efficacy characteristics as propofol with less incidence of side effect. Both ciprofol and propofol are often used in outpatient hysteroscopic surgery for sedation. However, the relative potency of these two drugs has not been fully determined in this context. Our study aimed to investigate the potency-ratio of ciprofol and propofol under procedural sedation and anesthesia in restraining reaction of outpatient hysteroscopy dilatation. The ED50 (effective dose in 50% of subjects) value for ciprofol and propofol were calculated by Up-and-Down Sequential Allocation Method. 60 healthy patients undergoing daytime hysteroscopy were randomly divided into two groups, which were intravenously injected with ciprofol at an initial dose of 0.4mg/kg (group C) or propofol at an initial dose of 2mg/kg (group P) at 2min after intravenous injection of sufentanil 0.15ug/kg. A successful response is defined as the absence of patient movement in the case of cervical dilation. Conversely, the presence of patient movement is defined as failure. After successful or failed responses, each follow-up patient in the corresponding group was reduced or increased with propofol 0.5mg/kg or ciprofol 0.1mg/kg, respectively. The estimated ED50 value for ciprofol and propofol in restraining reaction of hysteroscopy dilatation was 0.444mg/kg (95% CI, 0.385-0.503mg/kg) and 1.985mg/kg (95% CI, 1.801-2.170mg/kg), respectively. The incidence of respiratory depression, hypoxemia and injection pain in ciprofol was significantly lower than those in propofol. The ED50 of ciprofol and propofol in preventing hysteroscopy dilatation reaction was 0.444mg/kg (95% CI, 0.385-0.503mg/kg) and 1.985mg/kg (95% CI, 1.801-2.170mg/kg) for outpatient hysteroscopy. The potency-ratio of ciprofol and propofol observed in our study was 1.0:4.5(95%CI,1:3.9-1:5.1). The study was registered at Chinese Clinical Trial Registry http//www.chictr.org.cn/ (Registration date19/11/22 Trial ID ChiCTR2200065954).

Comparison of hypotension between propofol and remimazolam-propofol combinations sedation for day-surgery hysteroscopy: a prospective, randomized, controlled trial

BackgroundA combination of remimazolam and propofol could produce more stable sedation. A good medication regimen should consider not only efficacy but also safety, especially hypotension. The aim of the current study was to compare the incidence and amount of hypotension by propofol versus remimazolam-propofol combinations in day-surgery hysteroscopy.MethodsPatients were randomly assigned to receive either propofol (Group P, n = 125) or remimazolam-propofol combinations (Group RP, n = 125) at a 1:1 ratio. Intravenous injection of sufentanil 0.1ug/kg were administered before sedative medication. In group P, a bolus of 2.5 mg/kg propofol was administered. In group RP, intravenous anesthesia was commenced with 0.125 mg/kg remimazolam and 1 mg/kg propofol. After loss of consciousness, propofol was maintained at 6 mg/kg/h. The primary outcomes were the incidence and amount of hypotension during surgery. Hypotension was defined as a MAP less than 65mmHg for at least 1 min. The amount of hypotension was assessed by time-weighted average intraoperative MAP under a threshold of 65 mmHg. The secondary outcomes were various anesthesia related parameters and some adverse events.ResultsIn group P, 25 patients (20.0%) experienced hypotension during hysteroscopy compared with 9 patients (7.2%) in group RP, for a difference of 12.8% (RR 2.778, 95%CI [1.352–5.709]). The combination of remimazolam and propofol resulted in significantly lower TWA (Time Weighted Average) threshold 0.14 (0.10–0.56) mmHg in group RP compared to 0.31 (0.15–0.67) mmHg in group P. The total dose of propofol was nearly double in group P compared to group RP. A significantly higher frequency of injection pain and low oxygen saturation was observed in the group P than that of the group RP. Hiccup was observed only in group RP. The incidences of body movement, bradycardia and vomiting were no significant difference between groups.ConclusionThe incidence and amount of hypotension by remimazolam-propofol combinations was significantly less than that by propofol sedation in day-surgery hysteroscopy. The optimization of medication regimen would attenuate the harm of hypotension and contribute to patients’ rapid recovery in day surgery.Trial registration Chinese Clinical Trial Registry, ChiCTR2400079888 (date: 15/01/2024),

Can Multimodal Analgesia Reduce Postoperative Opioid Consumption in Patients Undergoing Shoulder Arthroscopy? A Retrospective Study.

The aim of this study was to investigate whether multimodal analgesia can decrease postoperative opioid usage in patients undergoing shoulder arthroscopy. Patients diagnosed with subacromial impingement syndrome who underwent acromioplasty at our institution between October 2022 and November 2023 were retrospectively analyzed. Patients were divided into an observation group and a control group based on postoperative pain management methods. The control group received intravenous self-controlled electronic analgesia (sufentanil injection 1 μg/kg + butorphanol injection 4 mg + 0.9% NaCl injection to 100 mL), while the observation group received multimodal analgesia (ropivacaine subacromial pump 3 mL/h, combined with oral celecoxib and acetaminophen). Visual Analog Scale (VAS) scores were recorded preoperatively and at various postoperative time points, and opioid usage, length of hospital stay, and analgesia-related complications within 1 week postoperatively were compared between groups. The 36-item Short Form Health Survey (SF-36) scores and the Constant-Murley score (CMS), were also assessed 1 day and 1 week after treatment. One hundred thirty-two patients were included in the study, 66 in the observation group and 66 in the control group. In the control group, there were 46 males and 20 females, with a mean age of 55.47 ± 11.42 years and in the observation group 44 males and 22 females, with a mean age of 56.13 ± 12.19 years The observation group consistently reported significantly lower pain intensity compared to the control group at 8 h (T1), 24 (T2), and 48 h (T3) after surgery (p < 0.05). Additionally, the observation group exhibited significantly lower opioid usage and complication rates compared to the control group (p < 0.05). SF-36 scores and CMS scores were significantly higher in the observation group 1 week after treatment compared to the control group (p < 0.05). Following shoulder arthroscopy, multimodal analgesia effectively reduces opioid consumption, lowers complication rates, and provides effective short-term pain relief. This approach carries significant implications for improving patient outcomes.

Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study.

Cough is one of the most common complications following intravenous administration of sufentanil during anesthesia induction. The study aimed to investigate the protective effect of alfentanil, afentanyl derivative with short onset time and short duration, in reducing sufentanil-induced cough. Eighty patients that scheduled for thyroid surgery under general anesthesia were randomly divided into the alfentanil group and normal saline group, with 40 cases per group. Patients in the alfentanil group received intravenous administration of 2 μg/kg alfentanil prior to sufentanil injection during general anesthesia induction, while the same dose of normal saline was administered in the normal saline group. The outcomes measures included the incidence and severity of cough and common side effects of opioids following the administration of sufentanil during the induction of general anesthesia, intraoperative hemodynamics parameters and major adverse events during anesthesia recovery period. The incidence of cough within one minute after the injection of sufentanil during anesthesia induction was 40% in the normal saline group, and the pretreatment of alfentanil significantly reduced the incidence of sufentanil-induced cough to 5% (p < 0.05). Correspondingly, the patients in the alfentanil group had decreased severity of sufentanil-induced cough compared with the normal saline group (p < 0.05). No significant differences in the incidences of common side effects of opioids (dizziness, nausea and vomiting, chest tightness and respiratory depression) within one minute after sufentanil injection were found (p > 0.05). Furthermore, there were no significant differences between the two groups in intraoperative hemodynamic parameters, extubation time, or the incidences of emergence agitation, respiratory depression, delayed recovery from anesthesia and postoperative nausea and vomiting during Postanesthesia Care Unit stay (p > 0.05). Pretreatment with low-dose alfentanil (2 μg/kg) effectively and safely reduced both the incidence and severity of sufentanil-induced cough during anesthesia induction. Chinese Clinical Trial Registry (identifier: ChiCTR2300069286).

Effect of Preadministration of Nalmefene on Sufentanil-Induced Cough During Induction of General Anesthesia in Patients Undergoing Breast Surgery: A Double-Blind Randomized Controlled Trial.

This study was designed to investigate the effects of preadministration of nalmefene before general anesthesia induction on sufentanil-induced cough (SIC) in patients undergoing breast surgery. A total of 105 patients scheduled for elective breast surgery under general anesthesia were selected and randomly assigned into three groups: normal saline (Group C), low-dose nalmefene 0.1 μg·kg-1 (Group LN), and high-dose nalmefene 0.25 μg·kg-1 (Group HN). Sufentanil 0.5 μg·kg-1 was injected intravenously within 2 s after 5 min of intervention. The count and severity of cough within 2 min after sufentanil injection, as well as the time to first cough, were recorded. In addition, we also collected intraoperative hemodynamic data, postoperative pain scores, the incidence of receiving rescue analgesics, and side effects up to 24 h after surgery. Compared to Group C, the incidence of SIC was significantly lower in Group LN and HN (64.7% vs 30.3% and 14.7%, respectively; P < 0.001), but no significant difference was observed between the two groups (P=0.126). Compared to Group C, the risk factors decreased by 53.4% (95% confidence interval [CI] =0.181-0.735, P=0.008) in Group LN and by 75.9% (95% CI=0.432-0.898, P=0.001) in Group HN. Of the patients with SIC, less frequent SIC within 2 min after induction and a lower proportion of severe coughs were observed than Group C (P < 0.05), and no difference was detected between Group LN and HN. Additionally, the onset time to the first SIC did not differ significantly between the groups. Intraoperative hemodynamic data, postoperative pain scores, and side effects in the first 24 h did not differ among the groups. Preadministration of nalmefene prior to induction of general anesthesia effectively suppressed SIC in patients undergoing breast surgery, without affecting intraoperative hemodynamic fluctuation and postoperative pain intensity.

Effect of pretreatment with a small dose of esketamine on sufentanil-induced cough during anesthesia induction: a randomized controlled trial

BackgroundSufentanil-induced cough is common during the induction of anesthesia. The objective of this study was to determine whether pretreatment with a small dose of esketamine is effective in treating sufentanil-induced cough.Methods220 patients were screened, and 200 patients who had scheduled elective surgery and were between 18 and 70 years old were randomly divided into two groups. Before sufentanil was administered, esketamine group (group K) was injected with 0.15 mg/kg esketamine at 5 s, and control group (group C) was administered with the same volume. Within 1 min after sufentanil(0.4ug/kg) injection during induction, cough incidence and severity were evaluated. After sufentanil was injected, we recorded its hemodynamic changes and side effects.ResultsIn the esketamine group (group K) and control group (group C), there was an incidence of cough of 5 and 34%, respectively. The esketamine group (group K) had a significantly lower incidence and severity of cough compared to the control group (group C) immediately after sufentanil injection (P < 0.05). MAP and HR did not differ significantly between the two groups during three different times of general anesthesia induction (P > 0.05).ConclusionIn our study, we found that sufentanil-induced cough was significantly reduced by pretreatment with 0.15 mg/kg esketamine, but with no significant changes in the hemodynamic status.Trial registrationChinese Clinical Trial Registry (ChiCTR2200063821, registered date: 17/09/2022), http://www.chictr.org.cn

Opioid infusions at different times of the day produce varying degrees of opioid-induced hyperalgesia

Opioids are metabolised by enzymes the activities of which vary with the circadian rhythm. We examined whether opioid infusions administered at different times of the day produce varying degrees of opioid-induced hyperalgesia (OIH) in animal experiments and clinical studies. Male Sprague-Dawley rats received remifentanil infusions (1 μg kg-1·min-1 for 1 h) at Zeitgeber times (ZT) 0, 4, 8, 12, 16, or 20 h. Rhythmicity of mechanical hypersensitivity was assayed after the infusion. Mechanical hypersensitivity, drug concentration, and metabolic enzyme activity of Wistar rats that received sufentanil (10 μg kg-1; four consecutive i.p. injections at 15-min intervals) or remifentanil infusion at ZT0 or ZT8 were assayed. Sixty patients who underwent abdominal laparoscopic surgery under general anaesthesia received remifentanil infusion (0.15 μg kg-1 min-1) and sufentanil injection (0.2 μg kg-1) at induction and skin incision, respectively. Postoperative pressure pain sensitivity, pain Numeric Rating Scale (NRS), drug concentrations, and nonspecific esterase activity were assessed. Sprague-Dawley rats that received remifentanil infusion exhibited a robust rhythmic paw withdrawal threshold (JTK_CYCLE: P=0.001, Q=0.001, Phase=26). Wistar rats infused with remifentanil or sufentanil at ZT8 exhibited greater OIH (P<0.001) than those infused at ZT0, with higher blood concentrations (P<0.001) and lower metabolic enzyme activities (P=0.026 and P=0.028, respectively). Patients in the afternoon group exhibited higher pressure pain sensitivity at forearm (P=0.002), higher NRS (P<0.05), higher drug concentrations (sufentanil: P=0.037, remifentanil: P=0.005), and lower nonspecific esterase activity (P=0.024) than the morning group. Opioid infusions administered at different times of day produced varying degrees of OIH, possibly related to circadian rhythms of metabolic enzyme activities. NCT05234697.

Combined sevoflurane/sufentanil anesthesia for removal of tracheal foreign bodies in pediatric surgery, and its effect on hemodynamics

Purpose: To determine the efficacy of sevoflurane + sufentanil combination anesthesia in pediatric surgery for removal of tracheal foreign bodies, and its effect on hemodynamics.Methods: A total of 128 children with airway foreign bodies were assigned to control and study groups, each with 64 children. The control patients received slow intravenous injection of propofol (3 mg/kg). The study group was given 5 % sevoflurane and a slow intravenous injection of sufentanil (0.3 μg/kg). Hemodynamic parameters (diastolic blood pressure, systolic blood pressure and heart rate) were recorded before induction of anesthesia, at the time of intubation, during placement of a rigid bronchoscope (when the lens was placed), during removal of foreign bodies, and when extubating. Complications in children in the two groups after the removal of airway foreign body were recorded.Results: At the times of intubation and extubation, blood pressure and heart rate were significantly increased in both groups, but appreciably lower values were seen in study group. The major complications in pediatric airway foreign body removal in two groups were vomiting, bronchospasm and holding of breath.Conclusion: In children with airway extraction, sevoflurane, in combination with sufentanil produced better anesthetic effect and less impact on hemodynamics than propofol. Moreover, the children woke up faster and had fewer complications. The combined anesthesia is safe and reliable. However, the clinical application of this combined anesthesia requires larger-sample clinical studies.

Sufentanil reduces myocardial apoptosis in rats with myocardial ischemia-reperfusion injury

Purpose: To determine the effect of sufentanil on myocardial apoptosis in rats with myocardial ischemia-reperfusion injury (MIRI).Methods: Fifty Sprague Dawley rats were randomly assigned to five groups: sham, model, low-dose, moderate-dose, and high-dose. The groups, except sham, underwent ligation of the left anterior descending coronary artery to establish the MIRI model. The low, moderate, and high-dose groups received intraperitoneal injections of sufentanil at different concentrations. Cardiac function, serum LDH, creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), superoxide dismutase (SOD) and malondialdehyde (MDA) content were evaluated. The mRNA expression levels of apoptosis genes and protein levels of p38 and p-p38 were assessed in myocardial tissues using various methods while apoptosis was assessed by TUNEL assay.Results: Compared to sham group, the model group exhibited significant decrease in fractional shortening (FS) and ejection fraction (EF), increase in CK activity, LDH, and MDA contents, lower SOD activity. Model group also showed increase in mRNA levels of B-cell lymphoma-2 (Bcl-2) and caspase- 3, higher apoptosis, significant increase in protein levels of p38 and p-p38, and higher level of myocardial apoptosis (p &lt; 0.05). High-dose group demonstrated significant increase in FS and EF, decrease in LDH content and CK activity, lower MDA content, higher SOD activity, decrease in mRNA levels of Bcl-2 and caspase-3, lower apoptosis, decrease in protein levels of p38 and p-p38, and lower level of myocardial apoptosis (p &lt; 0.05), when compared with model group.Conclusion: High-dose sufentanil reduces myocardial apoptosis and improves cardiac function, and thus can potentially be developed as a cardioprotective agent.

Intraoperative Sufentanil Consumption and the Risk of Postoperative Nausea and/or Vomiting: A Retrospective Observational Study.

Post-operative nausea and/or vomiting (PONV) is a common post-operative adverse reaction and has been associated with post-operative sufentanil injection. The assessment of the relationship between intraoperative opioid consumption and PONV has been understudied. This study examined the relationship between intraoperative sufentanil administration and PONV. This was a single-center retrospective observational study. Patients who underwent video-assisted thoracoscopic surgery under general anesthesia with the preoperative thoracic paravertebral block between January 2017 and June 2020 at the Peking University People's Hospital were recruited for this study. Patients were grouped into two groups according to whether or not PONV occurred on postoperative day 1 (POD1). The factors associated with PONV were analyzed using logistic regression. A total of 2733 patients, 1510 males and 1223 females, were included in this study. Among them, 143 patients developed PONV, a 5.2% (143/2733) PONV incidence. Logistic regression analysis showed that female, nonsmoking, sufentanil patient-controlled intravenous analgesia (PCIA), POD1 opioids consumption, and a time-weighted average of intraoperative sufentanil (twSuf) were associated with PONV. All patients were further divided into four subgroups based on intraoperative twSuf. Logistic regression analysis revealed that twSuf higher than 0.21μgkg-1h-1 was an independent risk factor for PONV. Intraoperative sufentanil injection with a twSuf higher than 0.21μgkg-1h-1 increased the risk of PONV in patients undergoing thoracoscopic surgery under general anesthesia after a preoperative thoracic paravertebral block.

Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting.

Sufentanil, a potent opioid, serves as the first option for perioperative analgesia owing to its analgesic effect, long duration and stable hemodynamics, whereas its side effects frequently blunt its application. The intravenous (IV) injection of sufentanil during anesthesia induction has high incidence of choking or bucking reaction, which is defined as sufentanil-induced cough (SIC). Moreover, postoperative nausea and vomiting (PONV) is a common and stressful complication, which is also related to the usage of opioid. High incidence of PONV is reported in the patients with SIC. Hence, we sought to determine whether naloxone, an opioid antagonist, at low dose would decrease the incidences of SIC and PONV. 216 female patients undergoing gynecological laparoscopic operation (<2h) under general anesthesia were recruited in this study, and randomly assigned into two groups: Group N (patients receiving naloxone and Group C (patients receiving vehicle). Sufentanil (0.5μg/kg within 5s) was given in anesthesia induction, and low-dose naloxone (1.25μg/kg) or identical vehicle was initially injected 5min prior to induction, with the incidence and severity of SIC estimated. Subsequently, naloxone or vehicle was continuously infused at the rate of 0.5μg/kg/h in the initiation of operation until the end of the operation, and the transverse abdominal fascia block (TAP) was performed for postoperative analgesia. The PONV profiles such as incidence and the severity, grading, and the frequencies of antiemetic usage within 24h were evaluated, with VAS scores and remedial measures for analgesia during the first 24h postoperatively were recorded. Our results revealed that one bolus of low-dose naloxone prior to the induction significantly mitigated the incidence of SIC, and intraoperative continuous infusion of low-dose naloxone reduced the incidence and the severity of PONV, so that the postoperative VAS scores and further remedial analgesia were not altered. These results not only provide clinical solutions for prophylaxis of SIC and PONV, but also suggests that opioids may act as a key role in both SIC and PONV, whereas opioid antagonist may hit two tasks with one stone. Moreover, further investigations are required to address the underlying mechanism of SIC and PONV. Clinical Trial Registration: [www.chictr.org.cn], identifier [ChiCTR2200064865].

Pupil Diameter Changes after Anesthesia with Different Doses of Sufentanil under Ultrasound Monitoring.

Objective This study aims to observe the changes in pupil diameter (PD) after anesthesia with different doses of sufentanil with the ultrasound method and observe whether pupil contraction is correlated with hemodynamic changes and bispectral index (BIS) values. Methods A total of 124 patients between the ages of 18–65 with ASA I–II undergoing general anesthesia for surgery were enrolled in the study. According to the sufentanil dose initially injected, they were randomly divided into groups P, S1, S2, and S3, with 31 cases in each group. Group P was injected with normal saline. Group S1 was injected with 0.2 μg/kg of sufentanil. Group S2 was injected with 0.4 μg/kg of sufentanil. Group S3 was injected with 0.6 μg/kg of sufentanil. Following propofol administration and eye closure, the pupil diameter (PD) of the patients in the four groups was observed and measured by ultrasound after the loss of consciousness (T1) and within 3 min after the sufentanil injection at an interval of 30 s (30 s (T2), 1 min (T3), 1 min 30 s (T4), 2 min (T5), 2 min 30 s (T6), and 3 min (T7)). PD, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and BIS values at T1–T7 were recorded. Results The ultrasonic method was used to observe that different doses of sufentanil could make the patients' pupils contract. During anesthesia induction, the changes in PD have a positive correlation with SBP, DBP, HR, and BIS values. Conclusion Ultrasound can become a new noninvasive method to monitor pupil changes during general anesthesia, and ultrasonic observation of pupil changes has great potential for individualized analgesia management in the perioperative period.

Comparison of a Small Dose of Oxycodone and Sufentanil for the Prevention of Sufentanil-Induced Cough during General Anesthesia Induction: A Prospective Randomized Controlled Trial.

Background Sufentanil is widely used during anesthesia induction. However, it can cause coughing via different mechanisms. This study is aimed at evaluating the effectiveness of a small dose of oxycodone and sufentanil in suppressing sufentanil-induced cough (SIC) during general anesthesia induction. Methods Of the 174 patients scheduled for elective surgery, 144 were eligible and randomly divided into 3 groups (n = 48). Five minutes before sufentanil bolus (0.4 μg/kg), patients in group O received 0.02 mg/kg oxycodone intravenously within 5 s, those in group S received 0.02 μg/kg sufentanil within 5 s, and those in group N received an equal volume of 0.9% normal saline within 5 s. Sufentanil was diluted to 5 μg/ml and administered within 5 s after pretreatment. The incidence and severity of cough in the three groups were evaluated within 1 minute after sufentanil injection during the anesthesia induction. Their mean arterial pressure (MAP) and heart rate (HR) were recorded at T0 (after entering the operation), T1 (3 minutes after pretreatment), T2 (before intubation), and T3 (1 minute after intubation). Results The incidences of cough in group N, group O, and group S were 20 (41.6%), 7 (14.5%), and 6 (12.5%), respectively. Compared with group N, patients from group O and group S exhibited significantly reduced incidence and severity of cough, and the severity of cough in group O and group S was significantly reduced compared with group N (P < 0.05). No significant differences in the rangeability of MAP and HR were noted at the four time points in the three groups (P > 0.05). Conclusion. Preconditioning using intravenous oxycodone (0.02 mg/kg) or sufentanil (0.02 μg/kg) could represent an effective approach to reducing SIC in anesthesia induction and was associated with relatively stable hemodynamic state during general anesthesia. This trial is registered at Chinese Clinical Trial Registry with registration number ChiCTR1900021087.

Safety and efficacy of microwave ablation to treat pulmonary nodules under conscious analgosedation with sufentanil: A single-center clinical experience.

The present study was designed to evaluate the safety and efficacy of computed tomography-guided percutaneous microwave ablation (MWA) to treat pulmonary nodules under conscious analgosedation with sufentanil. February to May 2021, 124 patients with 151 pulmonary nodules were enrolled in this study. The patients underwent 124 sessions of MWA. Sufentanil (0.25 μg/kg) was injected intravenously before MWA. The technical success was 100% and no procedure-related deaths. The dosage of sufentanil was 16.6 ± 3.0 μg. The mean tumor diameter in the enrolled patients was 1.3 ± 0.8 cm. The intraoperative mean numerical rating scale (NRS) was 2.2 ± 1.7. Among the patients with NRS >3, seven patients had nodules adjacent to the pleura, while in ten patients, they were not adjacent. The mean systolic, diastolic blood pressure, and heart rate of patients were 139.1 ± 23.5 mmHg, 77.8 ± 12.3, and 76.1 ± 13.4 times/min, respectively, before sufentanil injection. The mean lowest systolic, lowest diastolic blood pressure, and lowest heart rate intraoperative were 132.9 ± 22.0 mmHg, 76.1 ± 12.1, and 74.0 ± 13.5 times/min. Twenty-six patients had mild adverse events including nausea (6.45%, 8/124), dizziness (2.42%, 3/124), vomiting(4.03%, 5/124), nausea and dizziness (2.42%, 3/124), nausea with vomiting and dizziness (2.42%, 3/124), urinary retention (1.61%, 2/124) and respiratory depression (0.81%, 1/124). Sufentanil is a feasible, safe, and effective analgesic for MWA in patients with pulmonary nodules. It can be used for clinical promotion.

Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

National drug utilization trend of analgesics in China: an analysis of procurement data at 793 public hospitals from 2013 to 2018

BackgroundThis research aimed to evaluate analgesic utilization in public hospitals from 2013 to 2018 by analyzing the procurement data of 793 hospitals in China.MethodsThis study applied a retrospective observational study by using a database of the Chinese Pharmaceutical Association. The final dataset covers 30 provinces and municipalities in China, with a total of 793 public hospitals with complete procurement records of analgesics from January 2013 to December 2018. Procurement cost and dosage utilization were analyzed through descriptive trend statistics.ResultsFrom the procurement cost data, analgesics mainly consisted of opioids and non-steroidal anti-inflammatory drugs (NSAIDs), and the annual cost of both types of drugs increased yearly. The 6-year total cost of opioids accounts for 57% (17,800 million CNY), followed by the cost of NSAIDs accounts for 37% (11,400 million CNY). From 2013 to 2018, the annual cost of opioids nearly doubled, while the annual cost of NSAIDs doubled. The total 6-year clinical drug dosage of opioids accounts for 45% (675 million total defined daily dose (DDD)), and the NSAIDs account for 50% (747 million total DDD). From 2013 to 2018, the annual clinical drug dosage of NSAIDs increased by about 0.6 times. The annual clinical drug dosage of opioids has more than doubled. The top three opioid drugs were dezocine injection, remifentanil injection, and sufentanil injection solution. the top three NSAIDs were flurbiprofen injection, parecoxib injection, and celecoxib oral solution.ConclusionIn China, analgesics utilization increased rapidly at public hospitals from 2013 to 2018. The utilization of analgesics was highly concentrated in NSAIDs and opioids. Within the two types of analgesics, the main analgesics utilization is also highly concentrated, with some highly risky analgesics. The rational guideline for the utilization of analgesics needs to be established with the support of real-world evidence.

Sufentanil EC50 for endotracheal intubation with aerosol inhalation of carbonated lidocaine by ultrasonic atomizer

BackgroundNebulized lidocaine reduced stress response for endotracheal intubation. However, the impact of novel lidocaine aerosol inhalation for intubation by ultrasonic atomizer was unclear. Hence, we designed aerosol inhalation of lidocaine by ultrasonic atomizer, to seek whether the dosage of sufentanil for intubation could be less or not.MethodsIntravenous injection of sufentanil started at 0.5 μg/kg, and sufentanil dosage was increased/decreased (step-size 0.05 μg/kg for sufentanil) using Dixon’s up and down method. The observation was terminated after 8 reflexes.ResultsThe EC50 and EC95 of sufentanil with lidocaine by ultrasonic atomizer for intubation were found to be 0.232 μg/kg (95% CI: 0.187–0.270 μg/kg) and 0.447 μg/kg (95% CI: 0.364–0.703 μg/kg). 55.88% out of 34 patients showed hemodynamic index change < 20% of baseline during intubation.ConclusionAerosol inhalation of lidocaine by ultrasonic atomizer reduced the dosage of sufentanil for endotracheal intubation. Lidocaine inhalation by ultrasonic atomizer for airway anesthesia with minimal dosage of sufentanil could be recommended, particularly in patients who need more stable hemodynamic changes or spontaneous respiration.Trial registrationChinese Registry of Central Trial, ChiCTR-IOR-17014198.Registered 28 December 2017.

Recommended dose of sufentanil during induction of general anesthesia to avoid coughing and drastic hemodynamic fluctuations in patients undergoing surgery.

BackgroundSufentanil-induced cough (SIC) is a common complication during anesthesia induction. We explored the recommended sufentanil dose that effectively avoids cough during general anesthesia using a clinical trial to analyze the effective dose (ED)50 and ED95 of sufentanil that avoids cough, hemodynamic fluctuations, and adverse reactions.MethodsOn the basis of sufentanil dose, 136 patients (ASA class I–II) were randomly allocated into the following groups: I, 0.1 μg/kg; II, 0.3 μg/kg; III, 0.5 μg/kg; or IV, 1.0 μg/kg. The number of coughing incidents, dizziness, panic, and chest tightness within 1 minute after sufentanil injection, and the patient’s heart rate (HR) and blood pressure 5 minutes after intubation were recorded and analyzed. Cough was assessed as follows: none, 0 times; mild, 1 to 2 times/minute; moderate, 3 to 4 times/minute; and severe, 5 times/minute or more.ResultsThe ED50 and ED95 of cough incidence induced by intravenous sufentanil in patients during general anesthesia induction was 0.332 μg/kg and 1.423 μg/kg, respectively. The cough rate in group I was lower than the other groups. The incidence of dizziness, panic, chest tightness, hypertension, bradycardia, and tachycardia were not significantly different.ConclusionsThe recommended sufentanil dose during general anesthesia induction is 0.1 μg/kg.