fentanyl

Reflex cough is a common complication after fentanyl injection during anesthesia. Several studies have tried different medications to control fentanyl-induced cough (FIC).

Our study evaluated the effect of different ketamine dosage on preventing fentanyl induced cough.

We randomly assigned 80 participants into four groups. Group 1 was administered 0.15 mg/kg, Group 2 received 0.2 mg/kg, Group 3 was given 0.25 mg/kg of intravenous ketamine one minute prior to fentanyl injections, while Group 4 received an equivalent volume of 0.9% normal saline.

The incidence and severity of cough was evaluated by FIC score. The incident of cough was significantly lower in Groups 3, 2 and 1 in comparison to Group 4 (0, 5, 30 respectively vs 85, p<0.001). The cough severity was significantly lower in Groups 3, 2 and 1 in comparison to Group 4 (p<0.001).

Intravenous ketamine 0.25 mg/kg, significantly decreased the severity and frequency of cough compared with 0.20 and 0.15 mg/kg IV ketamine.

Sufentanil is extensively used as a powerful painkiller for both initiating and sustaining general anesthesia, thanks to its advantages like potent prolonged action, analgesic effect, and hemodynamic stability. Nonetheless, it's important to consider sufentanil's negative side effects, such as postoperative nausea and vomiting (PONV), during the surgical period. Additionally, Naloxone, an antagonist for opioid receptors, is frequently utilized to counteract the lingering effects of opioids after surgery. Hence, we examined the preventative use of low-dose naloxone on PONV and studied its potential mechanism of action.

After ethical approval and receiving IRCT code, 64 patients were evenly assigned to the naloxone and ondansetron groups prior to surgery. We also monitored the occurrence and intensity of PONV and the use of antiemetic medication within the first 24 hours after surgery. The main focus of our study was to analyze the PONV profile.

The mean age was 49.8±15.5 years, the mean weight 71.8±23 kg, and the mean BMI was 23.5±5.2 kg/m2. No significant difference was detected regarding mean oxygen saturation and arterial pressure between the groups at admission, 15, 30, 60, and 90 min after surgery (p> 0.05). Adverse reactions showed no significant difference during the recovery time between the groups (p> 0.05). The PONV severity and incidence are significantly higher in the naloxone group.

Naloxone can be used as an antiemetic medicine, besides the ondansetron, and using this agent individually cannot prevent nausea and vomiting effectively.

Currently Awake fibreoptic intubation - (AFOI) is the gold standard for the management of patients with an anticipated difficult airway. Various medications have been used to perform intubation during AFOI. The ideal drug for AFOI must provide comfort, cooperation, amnesia and hemodynamic stability along with maintenance of spontaneous respiration. The study aimed to compare fentanyl, clonidine and dexmedetomidine in providing favourable intubating conditions along with hemodynamic stability during AFOI.

This prospective and randomized trial was carried out in 90 patients who were scheduled for elective surgery and required awake fibreoptic intubation. The patients were randomly divided into three different groups; Group A: Received Injection Dexmedetomidine-1ug/kg over 10 minutes; Group B: Received Injection Clonidine -2ug/kg over 10 minutes; and Group C: Received Injection Fentanyl- 2ug/kg over 10 minutes. Cough score, post-intubation score, Ramsay sedation score (RSS) and the changes in hemodynamic, were used to evaluate the effectiveness of the intubation condition and the results were then compared among the groups.

Demographic variables such as gender, age, weight and American Society of Anaesthesiologists-Physical Status ASA-PS (I/II) were comparable among the three groups and not statistically significant. The cough score and the post intubation score were lower in Group A. RSS was noted to be higher in Group A and there was a lower incidence of desaturation. Hemodynamic parameters were also favourable in Group A.

Dexmedetomidine was found to be more effective than clonidine and fentanyl in those undergoing awake fibreoptic intubation.  There were fewer adverse effects such as coughing, discomfort, oxygen desaturation, and intolerance to intubation.

Sleeve gastrectomy (SG) is an effective method for managing obesity. While opioids are used for their hemodynamic stability and their ability to reduce intraoperative stress, they also have reported side effects. Dexmedetomidine (DEX), an α2 adrenergic receptor agonist, is noted for its analgesic and anesthetic-sparing effects, leading to a higher quality of recovery.

The study aims to compare the effects of fentanyl and dexmedetomidine (DEX) on the recovery of morbidly obese patients following laparoscopic sleeve gastrectomy (SG).

This randomized, double-blind study involved 64 patients, equally divided into two groups. The Dexmedetomidine group (Group D) received an intravenous (IV) loading dose of dexmedetomidine (1 μg/kg) over 15 minutes before anesthesia induction, followed by a 10 mL saline 0.9% infusion over 60 seconds during induction. Post-intubation, dexmedetomidine was administered at 0.5 μg/kg/h. The Fentanyl group (Group F) received a volume-matched saline 0.9% IV over 15 minutes pre-induction and fentanyl (1 μg/kg) diluted in 10 ml saline 0.9% IV over 60 seconds during induction. After intubation, a continuous fentanyl infusion was maintained at a rate of 1 μg/kg/hr.

Extubation time was significantly shorter in the Dexmedetomidine group (Group D) at 8.25 ± 2.7 minutes compared to the Fentanyl group (Group F) at 10.47 ± 2.17 minutes, with a P-value of 0.001. Intraoperative heart rate and mean arterial blood pressure were also significantly lower in Group D than in Group F. Visual analogue scale (VAS) pain scores were significantly lower in Group D compared to Group F upon arrival at the post-anesthesia care unit and at 2 hours postoperatively (P-value < 0.05). Additionally, the morphine dose consumed in the first 12 hours after surgery was significantly lower in Group D (5.75 ± 2.20 mg) compared to Group F (8 ± 2.38 mg), with a P-value of 0.001.

For morbidly obese patients undergoing laparoscopic sleeve gastrectomy, dexmedetomidine (DEX) proves to be an effective anesthetic choice. It not only reduces extubation time but also lowers early postoperative visual analogue scale (VAS) pain scores and opioid consumption within the first 12 hours following surgery.

Dexmedetomidine and Fentanyl both possess hypnotic, sedative, analgesic properties and have been utilised as an additive in epidural anaesthesia. The purpose of this study is to compare the sedative and analgesic effects of Dexmedetomidine and Fentanyl when added epidurally with Ropivacaine (0.75%) during lower limb orthopaedic surgery.

The study comprised of 60 patients, both male and female, aged 18 to 60, who had ASA classification I or II for tibia fibula surgery. Two groups of patients were split up at random: Group RD contains–Ropivacaine (0.75%) 15ml + Dexmedetomidine (1microgm/kg) 0.5ml + 0.5ml sterile water (Total volume-16ml) and Group RF -Ropivacaine 15ml (0.75%) + 1ml Fentanyl (1microgm/kg) (Total volume-16 ml). The epidural space was maintained 4 cm within and situated between L3 and L4 space. Investigations were conducted on parameters such as sensory and motor block features, sedation score, hemodynamic factors and pain assessment. Using the student `t` test, statistical analysis was performed using STATAIC13 software.

Onset of sensory analgesia at L1 and Complete sensory and motor blockage occurred much earlier in the RD group. Higher sedation scores and significantly prolonged postoperative analgesia was observed in RD group.

Dexmedetomidine is a safer and more effective epidural adjuvant than fentanyl because it provides stable hemodynamics, extended post-operative analgesia, early onset and development of sensory and motor effects and sedation.

In this perspective review, we evaluated the clinical management of fatal fentanyl overdose in several routes of administration, concentrating on both legally prescribed and illegally produced formulations.

A literature search was conducted on Web of Science, PubMed, and Google Scholar databases, using the following keywords: fentanyl, illicit fentanyl, deaths, misuse, abuse, and naloxone. We included only articles whose abstracts were available in English. All articles were screened using their abstracts to determine their relevance to the current review.

The gold standard for treating both acute and chronic pain is fentanyl, but abuse of the drug has exploded globally since the late 2000s. Fentanyl abuse has been shown to frequently result in serious harm and even death.

By educating patients and physicians, making rescue kits easily accessible, developing vaccines to prevent opioid addiction, and perhaps even creating new tamper-resistant fentanyl formulations, it may be possible to prevent fentanyl misuse, therapeutic errors, and the repercussions that follow.

Background &  The presence of anesthetic drugs in the serum with possible negative effects on FSH and LH hormone concentration and vital signs has been shown in a number of experimental and human research.To measure the effects on blood hormone concentration and the effect on the vital signs (blood pressure and heart rate) of two different medications (remifentanil vs. fentanyl) used for general anesthesia during oocyte retrieval.Materials &  The present prospective comparative study was carried out at Iraq's "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Reproductive Physiology/Al-Nahrain University/Baghdad/Iraq" infertility center with the approval of the Faculty of Science's ethical committee. Mansoura University approved the study's validity. Ninety infertile women who are undergoing intracytoplasmic sperm injections (ICSI) for a variety of infertility-related reasons. The women ranged in age from 25 to 45. The study's original December 2022 deadline was pushed out to December 2023. Patients were split into two groups based on the general anesthesia technique for oocyte retrieval. Group one (45 patients) received midazolam, propofol, and fentanyl; group two (45 patients) received remifentanil, midazolam, and propofol. We compared the FSH and LH hormone levels before and after anesthesia and also compared the effect of anesthesia on vital signs between two groups of patients before and after anesthesia; accordingly, there was significantly higher systolic blood pressure in remifentanil group (p=0.30); however, there were no significant differences in diastolic blood pressure (p=0.767) and heart rates (p=0.512). The associations of LH and FSH with anesthesia are different depending on the type of anesthetic drugs.

The presence of anesthetic drugs in the serum with potential negative effects on hormone concentration and pregnancy rate has been shown in a number of human research. To assess the effects on blood hormone concentration and pregnancy rate of two different medications (remifentanil vs. fentanyl) used for general anesthesia during oocyte retrieval.

the present prospective comparative study was conducted at Iraq's "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Al-Nahrain University/Baghdad/Iraq" infertility center and was approved by Mansoura University for its validity. Sixty infertile women who were having (ICSI) for a range of infertility-related reasons that entered the study. The women's ages varied from 20 to 45 years. The study's length was extended from September 2022 to September 2023. According to the general anesthetic protocol for oocyte retrieval, those patients were divided into two groups. Midazolam, propofol, and fentanyl were given to the group one, while remifentanil, midazolam, and propofol were given to the group two.

Compare the hormone levels before and after fentanyl anesthesia. The current study's findings indicated that remifentanil led to a greater pregnancy rate (40.0%) than fentanyl (36.7%). According to the results, there were significantly higher LH levels after fentanyl anesthesia (P = 0.014). However, insignificantly higher FSH (P = 0.481) and prolactin (P = 0.076) levels post-fentanyl anesthesia. Also, significantly higher LH levels after remifentanil anesthesia (P = 0.046), insignificantly higher FSH levels (P = 0.383) and prolactin levels (P = 0.16) after remifentanil anesthesia. In the fentanyl group, the recovery time was substantially longer (P<0.001).

Because of its quicker recovery time and much greater pregnancy rate, remifentanil is preferred over fentanyl in normal general anesthetic treatments for egg harvest in ICSI operations.

 Total hip replacement (THR) is frequently associated with intense post-surgical pain. Effective pain management is of crucial importance to improving patient's condition and increasing his/her satisfaction in the post-operative time.

 This study aimed to compare the analgesic effect and safety of oxycodone and fentanyl after THR.

 Seventy-two cases scheduled for elective THR were included in this randomized, triple-blind trial. The patients were equally randomized into 2 groups: fentanyl group (50 ug of fentanyl) and oxycodone group (oxycodone 4 mg). Drugs were received 20 min prior to the end of the operation.

 Post-operative visual analog scale (VAS) measurements at rest and movement at the post-anesthesia care unit (PACU) and in the ward, 2 h, 4 h, and 8 h post-operatively exhibited a significantly reduced value in the oxycodone group compared to the fentanyl group (P-value < 0.05). Time to first rescue for analgesia was delayed significantly in the oxycodone compared to the fentanyl group (P-value < 0.001). Fentanyl consumption (ug) in the 1st post-operative 12 h, 24 h, and 48 h decreased significantly in the oxycodone group compared to the fentanyl group (P-value < 0.001). Post-operative nausea, vomiting, headache, and pruritus were matched between the 2 groups (P > 0.05).

 A bolus dose of 4 mg of oxycodone provided superior analgesic efficacy than 50 ug fentanyl as evidenced by significantly lower pain score, delayed onset to first request for analgesia, and the smaller amount of fentanyl consumption at 12, 24, and 48 h post-total hip arthroplasty compared to fentanyl. The incidence of adverse events was comparable between the 2 groups.

Etomidate is mentioned as one of the rapid intravenous anesthetic drugs whose unique characteristics include hemodynamic stability, negligible respiratory depression, and brain protection. The most common complication of etomidate is intravenous pain during injection. The purpose of this study was to compare the effectiveness of the Valsalva maneuver and fentanyl in reducing the pain caused by etomidate injection for anesthesia induction. This clinical trial was performed on 96 patients at Alzahra hospital, affiliated with the Isfahan University of Medical Sciences, from January to June 2021. Patients were divided into two groups of 48 people: the Valsalva maneuver group (group 1) and the fentanyl group (group 2). Blood pressure, heart rate (HR), oxygen saturation, and pain of etomidate injection using the withdrawal response score were graded on a four-point scale (no pain = zero, mild pain = 1, average pain = 2, and severe pain = 3). The collected information was entered into SPSS software version 24. Then, the pain score in the two groups was compared using the chi-square test. The significance level in the present study was P < 0.05. The mean HR (P = 0.07), mean arterial pressure (MAP) (P = 0.33), systolic pressure (P = 0.90), diastolic pressure (P = 0.67), and oxygen saturation level (P = 0.27) at different times between the two groups showed no significant difference (P > 0.05). However, during the etomidate injection, the HR increased and after the injection, the HR decreased in both groups (P = 0.042). The two groups had no significant difference regarding pain frequency. There was no difference in the effect of the Valsalva maneuver and fentanyl on reducing the pain caused by etomidate injection.

Spinal anaesthesia is the most common technique used for lower abdominal surgeries. Spinal anaesthesia using plain hyperbaric bupivacaine has disadvantages like delayed onset, shorter duration etc. Adding adjuvants like fentanyl, dexmedetomidine has overcome these disadvantages and improve post operative analgesia and stable hemodynamic condition with minimal side effects. Aim of the study was to determine the time of onset and duration of sensory and motor block, sedation score and postoperative analgesic efficacy of Fentanyl and Dexmedetomidine as adjuvant to bupivacaine in lower abdominal surgeries.

This prospective, double blind, randomized study included total 100 patient-divided equally in 2 groups (group F-fentanyl and group D-dexmedetomidine) after matching the inclusion and exclusion criteria. Group F received 3ml of 0.5 % injection Hyperbaric Bupivacaine + 25 mcg Fentanyl and Group D received 3ml of 0.5 % injection Hyperbaric Bupivacaine + 5mcg Dexmedetomidine intrathecally. The onset and duration of sensory and motor block, sedation score, duration of postoperative analgesia and need of rescue analgesia along with haemodynamic parameters were recorded.

The mean time for onset of sensory block in group D was (3.5 ± 0.88 mins) significantly lower than group F (4.4 ± 1.2 mins) (p=0.001). And the mean time of onset of motor block in group D (3.23 ± 1.0mins) was significantly lower than in group F (4.3 ± 1.1 mins). Duration of sensory and motor block was significantly higher in group D as compared to group F. The mean analgesic dose in group D was 1.4 ± 0.78 and in group F was 3.6 ± 0.73(p<0.005).

From our study we concluded that Dexmedetomidine is a better adjuvant than Fentanyl as it provides rapid onset and prolonged sensory and motor block, hemodynamic stability with excellent post operative analgesia.

 Colonoscopy is an invasive and short-term diagnostic-therapeutic method that is associated with significant pain, discomfort, and anxiety in patients. Thus, various sedation and analgesia methods are used to reduce these complications.

 This study compared the effect of dexmedetomidine versus intravenous lidocaine on colonoscopy candidates under sedation with propofol-fentanyl.

 This double-blind clinical trial was conducted on two groups of randomly divided patients (n = 60 each) referring to the colonoscopy unit of Imam Khomeini Hospital in Ahvaz, Iran. The first group was given 2% intravenous lidocaine with an initial dose of 1.5 mg/kg and a maintenance dose of 1 mg/kg/h, plus propofol 0.5 mg/kg and 1 µg/kg fentanyl. In contrast, the second group was given dexmedetomidine with an initial dose of 1 µg/kg and a maintenance dose of 0.5 µg/kg/h plus 0.5 mg/kg propofol and 1 µg/kg fentanyl. Hemodynamic changes, degree of sedation, and patients' pain were measured and recorded at certain intervals.

 No significant differences were observed between the dexmedetomidine and lidocaine groups regarding gender, age, and weight (P > 0.05), and the two groups were homogeneous in this regard. The two groups were significantly different with respect to their heart rate after sedation (from 5 to 20 minutes) (P < 0.05), which was lower in the group receiving dexmedetomidine. In terms of mean arterial blood pressure, no significant difference was found between the dexmedetomidine and lidocaine groups (P > 0.05). With respect to the pain score at the end of the procedure, the two groups were significantly different (P < 0.05), with the group receiving dexmedetomidine obtaining a lower score.

 Although the use of lidocaine and dexmedetomidine is associated with the least hemodynamic changes, dexmedetomidine can create more suitable and favorable conditions during and after colonoscopy by inducing a higher degree of sedation and more analgesia.

 Laryngoscopy is the required procedures in general anesthesia that can cause cardiovascular disorders for the patient. Various pharmacological methods are used to reduce unwanted laryngoscopy responses.

 The present study aimed to compare the effects of fentanyl and nitroglycerin spray on hemodynamic responses during laryngoscopy.

 In a clinical trial study, 40 patients were divided into two groups. In one group of patients, intravenous fentanyl (2 µg/kg) was given and in the other group, 2 puffs sublingually nitroglycerin spray was given in addition to receiving fentanyl. Hemodynamic variables were measured at one minute before and after laryngoscopy. The data was analyzed using SPSS version 19 software.

 The study data showed that there is no statistically significant difference between the study groups in terms of demographics. Systolic and diastolic blood pressure, as well as heart rate decreased significantly in the group of receiving simultaneous fentanyl and nitroglycerin in comparison to the group receiving fentanyl alone.

 The results of our study showed that the administration of nitroglycerin spray with fentanyl more weakened the cardiovascular responses induced by laryngoscopy.

The Sydney Children’s Hospitals Network (SCHN) addressed the challenges of the COVID-19 pandemic by implementing innovative changes which made their health system resilient and responsive. For other healthcare systems, there are important takeaways. In the United States and Canada, an urgent widespread response is needed to address the overdose crisis, driven by potent synthetic opioids (ie, fentanyl and its derivates). We project the COVID-19 System Shock Framework (CSSF) on to the North American healthcare systems and suggest a Fentanyl System Shock Framework, which provides a framework for necessary changes and innovations to address the overdose crisis. To become resilient to the fentanyl system shock, core components as well as overarching values, health policy, and online technologies need to be adapted to reduce the death count and meet the evolving needs of marginalised individuals who use opioid. Future research should focus on scientifically assessing such implementations to guide evidence-based decision making.