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At least 109 records · Page 6Linked to original sources

PubMed1983

[Comparison of the hemodynamic effects of midazolam-fentanyl and thiopental-fentanyl combinations in the induction of general anesthesia].

The hemodynamic changes during anesthetic induction for elective abdominal aortic surgery were studied in two groups of patients. Group M (9 patients) received midazolam 0.3 mg . kg-1 and fentanyl 6 micrograms . kg-1. Group T (10 patients) received thiopentone 6 mg . kg-1 and fentanyl 5 micrograms . kg-1. The radial and pulmonary arteries were catheterized under local anesthesia. An intravenous infusion was administered in order to normalize pulmonary wedge pressure. Systemic and pulmonary arterial pressures, pulmonary wedge pressure, cardiac output and heart rate were measured after the infusion and 5 min after intubation. Mean arterial pressure showed a statistically significant reduction in both groups. Cardiac index remained unchanged in group M, but was significantly diminished in group T. There was no significant reduction in the systemic vascular resistance index for group M, but group T showed a statistically significant increase. This study confirmed the good hemodynamic tolerance of the midazolam induction technique, even with a high dose of 0.3 mg . kg-1.

Adult↗

PubMedDate not supplied

Studies on fentanyl and related compounds IV. Chromatographic and spectrometric discrimination of fentanyl and its derivatives.

Chromatographic and spectrometric discrimination of fentanyl and its 24 analogues are discussed. Twenty-three of 25 samples were discriminated from each other by gas chromatography (GC), and the combination of GC and mass spectrometry enabled discrimination of all 25 samples. Condensed-phase infrared spectrometry was also useful for the differentiation of structurally similar compounds, but vapor-phase infrared spectra were not useful for discrimination of fentanyls.

Fentanyl↗

PubMed2001

A comparison of 0.0625% bupivacaine with fentanyl and 0.1% ropivacaine with fentanyl for continuous epidural labor analgesia.

UNLABELLED: We compared the analgesic efficacy and the degree of motor block achieved with epidural infusion of 0.0625% bupivacaine (Group B) versus 0.1% ropivacaine (Group R), both with 0.0002% fentanyl (2 microg/mL) in laboring patients. A prospective, double-blinded study was performed in 98 ASA physical status I-II parturients who were divided randomly into two groups to receive either bupivacaine or ropivacaine after catheter location had been tested with an initial bolus of lidocaine and fentanyl. The infusion rate was 15 mL/h in every case. When pain was perceived, 5-mL boluses of the assigned epidural analgesic were administered every 10 min until analgesia was achieved. We recorded pain intensity, level of sensory block, degree of motor block, hemodynamic variables, secondary effects, mode of delivery, neonatal outcome, and patient satisfaction. There were no statistically significant differences in any of the factors analyzed. Highly effective analgesia was achieved in both groups with a small incidence of motor block. These findings suggest that bupivacaine may be more potent than ropivacaine. IMPLICATIONS: We compared different concentrations of epidural bupivacaine and ropivacaine thought to be equipotent. Both solutions were equally efficient in providing highly effective epidural analgesia for labor with minimal motor block. These findings suggest that bupivacaine may be more potent than ropivacaine.

Adult↗

PubMed1987

A comparison between the effects of fentanyl, droperidol with fentanyl, and halothane anaesthesia on intra-ocular pressure in adults.

The effects of fentanyl 3.0 micrograms/kg (group 1), droperidol 0.1 mg/kg with fentanyl 3.0 micrograms/kg (group 2), and halothane 0.5% inspired concentration (group 3) on intra-ocular pressure were compared. In each group, a decrease in intra-ocular pressure was produced which was significantly lower than resting values (p greater than 0.01) and was independent of changes in arterial blood pressure. The recovery time in group 1 patients was significantly less than that of patients in group 3.

Aged↗

PubMed1991

Patient-controlled on-demand epidural fentanyl. A comparison of patient-controlled on-demand fentanyl delivered epidurally or intravenously.

A prospective, open, clinical trial is described in which 20 patients having upper abdominal surgery were randomly allocated to receive fentanyl for postoperative analgesia by patient-controlled demand analgesic computer by either the epidural or intravenous route. Hourly pain, sedation and nausea scores were very similar in the two groups during the first 24 hours after surgery. What few differences there were favoured the epidural group. There was a highly significant difference in fentanyl consumption between the two groups, with the intravenous group demanding consistently more than twice as much as the epidural group.

Adult↗

PubMed1998

Dose-titration, multicenter study of oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients using transdermal fentanyl for persistent pain.

PURPOSE: Supplemental, "as-needed," administration of an opioid is a common approach to the problem of breakthrough pain in cancer patients. Oral transmucosal fentanyl citrate (OTFC) is undergoing investigation as a new treatment for breakthrough pain. The primary purpose of the study was to demonstrate that a single-unit dose of OTFC can safely and effectively treat breakthrough pain. A secondary goal was to determine appropriate dosing guidelines. PATIENTS AND METHODS: This was a multicenter, randomized, double-blind, dose-titration study in 62 adult cancer patients using transdermal fentanyl for persistent pain. Consenting patients provided 2 days of baseline data to evaluate the performance of their usual breakthrough pain medication. Patients then randomly received 200 microg or 400 microg OTFC in double-blind fashion. (Patients were always assigned, rather than randomized, to 200 microg if 400 microg represented > 20% of around-the-clock medication.) Pain intensity (PI), pain relief (PR), and global satisfaction scores were recorded. OTFC was then titrated until the patient received adequate PR for each episode using one OTFC unit. Orders to titrate up were ignored one third of the time to improve the blind. Two days of baseline data were compared with 2 days of OTFC data after titration identified an effective dose of OTFC. RESULTS: Most patients (76%) found a safe and effective dose of OTFC. There was no meaningful relationship between the around-the-clock opioid regimen and the effective dose of OTFC. In open-label comparisons, OTFC produced a faster onset of relief and a greater degree of PR than patients' usual breakthrough medication. Somnolence, nausea, and dizziness were the most common side effects associated with OTFC. CONCLUSION: Most patients find a single OTFC dosage that adequately treats breakthrough pain. The optimal dose is found by titration and is not predicted by around-the-clock dose of opioids.

Administration, Buccal↗

PubMed1993

Fentanyl citrate (fentanyl sublimaze).

Fentanyl (Sublimaze) is a synthetic opioid used as a combination drug for conscious sedation in patients requiring endoscopic diagnostic and therapeutic procedures. Fentanyl is generally used in place of meperidine (Demerol) in combination with droperidol (Inapsine) and midazolam (Versed), creating neuroleptanesthesia for patients undergoing procedures that require patient cooperation.

Adjuvants, Anesthesia↗

PubMed1990

Atropine-induced heart rate changes: a comparison between midazolam-fentanyl-propofol-N2O and midazolam-fentanyl-thiopentone-enflurane-N2O anaesthesia.

Atropine-induced heart rate (HR) changes were studied in 19 patients (ASA physical status I) during anaesthesia-maintained predominantly with propofol-N2O or thiopentone-enflurane-N2O. Ten patients (Group A) received midazolam (0.07 mg.kg-1), fentanyl (1 microgram.kg-1), propofol (2 mg.kg-1) and succinylcholine (1 mg.kg-1). Following tracheal intubation, anaesthesia was maintained with propofol (6 mg.kg-1.hr-1), N2O (67 per cent) and O2 (33 per cent). In nine patients (Group B) thiopentone (4 mg.kg-1) was substituted for propofol and anaesthesia maintained with N2O (67 per cent) O2 (33 per cent), and enflurane (0.5 per cent inspired concentration). The study was non-randomised because Group B patients were only included if HR before administration of atropine less than 90 beats.min-1. IPPV was performed in all patients using a Manley ventilator (minute vol. 85 ml.kg-1; tidal vol. 7 ml.kg-1). Ten minutes after tracheal intubation, incremental doses of atropine (equivalent cumulative doses: 1.8, 3.6, 7.2, 14.4, 28.8 micrograms.kg-1) were administered at two-minute intervals and HR responses calculated during the last 45 sec of each intervening period. No differences were observed between the groups following 1.8 and 3.6 micrograms.kg-1 atropine, but propofol-N2O anaesthesia was associated with reduced responses (P less than 0.01) following 7.2, 14.4 and 28.8 micrograms.kg-1 atropine. These results suggest that there is a predominance of parasympathetic influences during propofol-N2O anaesthesia compared with thiopentone-enflurane-N2O anaesthesia.

Adult↗

PubMed2001

A comparison of ropivacaine with fentanyl to bupivacaine with fentanyl for postoperative patient-controlled epidural analgesia.

UNLABELLED: Ropivacaine for patient-controlled epidural analgesia (PCEA) may facilitate postoperative patient mobilization because it causes less motor block than bupivacaine. Forty patients undergoing abdominal surgery were randomized in a double-blinded manner to the following: 0.05% bupivacaine/4 microg fentanyl, 0.1% bupivacaine/fentanyl, 0.05% ropivacaine/fentanyl, or 0.1% ropivacaine/fentanyl for standardized PCEA. We measured pain scores, side effects, and PCEA consumption for 42 h. Lower-extremity motor function was assessed with electromyography and isometric force dynamometry. Analgesia was equivalent among groups. Local anesthetic use was more in the 0.1% Ropivacaine and 0.1% Bupivacaine groups (77% increase, P = 0.001). Motor function decreased during PCEA (10%-35% decrease from preoperative, P < 0.001) and was equivalent among groups. Eight patients were transiently unable to ambulate. These patients used more local anesthetic (45 vs 33 mg mean, P < 0.05) with additional decrease in motor function (32%, P < 0.004) compared with ambulating patients. Other side effects were mild and equivalent among solutions. PCEA with bupivacaine/fentanyl and ropivacaine/fentanyl as 0.05% or 0.1% solutions appears clinically equipotent. Lower-extremity motor function decreases, but is unlikely to result in prolonged inability to ambulate. Use of a 0.05% solution may be advantageous to decrease local anesthetic use and prevent transient motor block. IMPLICATIONS: Patient-controlled epidural analgesia with bupivacaine/fentanyl and ropivacaine/fentanyl as either 0.05% or 0.1% solutions are clinically similar. Lower-extremity motor function will decrease with the use of any of these combinations, but is unlikely to result in the inability to walk.

Amides↗

PubMedDate not supplied

A comparison of transcutaneous PO2 in patients sedated with diazepam-fentanyl or midazolam-fentanyl.

Fifty oral and maxillofacial surgery patients undergoing outpatient surgical removal of third molars under intravenous conscious sedation comprised the study group. All patients received 1 microgram/kg of fentanyl prior to receiving either diazepam or midazolam. The results show no statistically significant differences in blood pressure or pulse over time between the two groups, nor was there a statistically significant difference between the transcutaneous PO2 responses of the groups. However, a statistically significant time effect as well as a group by time interaction was present. Both groups show respiratory depression at the 8- and 10-minute time intervals. The use of supplemental oxygen and monitoring of respiration is recommended with the use of these drug combinations.

Blood Gas Monitoring, Transcutaneous↗

PubMed2001

A comparison of bupivacaine-fentanyl-morphine with bupivacaine-fentanyl-diamorphine for caesarean section under spinal anaesthesia.

In a randomised double-blind trial, postoperative analgesia and side effects of intrathecal morphine 0.1 mg and intrathecal diamorphine 0.25 mg were compared. Sixty women were randomised to receive intrathecal injection of 12.5 mg hyperbaric bupivacaine and 12.5 microg fentanyl with either morphine 0.1 mg (group M), or diamorphine 0.25 mg (group D). All women received 100 mg diclofenac rectally at the end of surgery and were given intravenous morphine via a patient controlled analgesia (PCA) system. Pain, PCA morphine usage and side effects were assessed at 2, 4, 8 and 24 h after spinal anaesthesia. The two groups were comparable for quality of intraoperative analgesia. There were no significant differences between the groups in time to first PCA demand, morphine consumption or oral analgesic use in each time period. Significantly more patients in group M were nauseated at 4 h whilst at 24 h nausea was significantly worse in group D. There was no significant difference between the groups in the number of women vomiting in the 24-h period. The two groups were comparable for pruritus and drowsiness. We conclude that 0.25 mg subarachnoid diamorphine is a suitable alternative to 0.1 mg morphine for post caesarean section analgesia.

Clinical Trial↗

PubMedDate not supplied