Comparison of the effect of adding midazolam versus fentanyl to intrathecal levobupivacaine in patients undergoing cesarean section: double-blind, randomized clinical trial

Abstract Background: Many adjuvants are added to prolong the effects of spinal analgesia. We investigated the postoperative analgesic efficacy of the addition of midazolam or fentanyl to intrathe-cal levobupivacaine in women undergoing cesarean delivery. Methods: Eighty patients were randomly assigned to two groups (n = 40). Group M received 10 mg of 0.5% levobupivacaine plus 2 mg of midazolam. Group F received 10 mg of 0.5% levobupivacaine plus 25 μg of fentanyl. Assessments included motor and sensory block, APGAR score, time to first request for analgesia, postoperative pain score, total consumption of rescue analgesics, and adverse effects. Results: Sensory blockade was prolonged in Group M compared with Group F (215.58 ± 27.94 vs. 199.43 ± 19.77 min; p = 0.004), with no differences in other characteristics of the spinal block in intraoperative hemodynamics or APGAR score. The mean time to first request for rescue analgesia was longer in Group M (351.45 ± 11.05 min) than in Group F (268.83 ± 10.35 min; p = 0.000). The median total consumption of rescue analgesics in the first 24 hours postoperatively was 30 mg in Group M vs. 60 mg in Group F (p = 0.003). The median Visual Analog Scale (VAS) scores were lower in Group Ethan in Group F from the 8th to the 12th hour postoperatively, with no differences between the groups at other time points. The incidence of adverse effects was higher in Group F than in Group M. Conclusion: Intrathecal midazolam (2 mg) was superior to intrathecal fentanyl (25 μg) in increasing the duration of the sensory blockade and postoperative analgesia with lower postoperative pain scores and decreasing the incidence of adverse effects.

Hemodynamic impact of increasing time between fentanyl and propofol administration during anesthesia induction: a randomised, clinical trial

Abstract Background and objective: Anesthesia induction can produce severe propofol dose-dependent hypotension. Fentanyl coadministration reduces the catecholaminergic response to orotracheal intubation allowing propofol dose reduction. The aim of this study is to determine whether the hemodynamic response is improved by increasing the time between fentanyl and propofol administration and reducing the dose of the latter without increasing the time to achieve optimal hypnosis. Methods: After approval by the Research Ethics Committee, patients undergoing non-cardiac surgery with endotracheal intubation were randomized by a computer-generated table into six time-dose groups (1 or 2 minutes/1, 1.5, or 2mg.kg-1 of propofol). Patients with high bronchoaspiration risk, a difficult airway, hemodynamic instability, or anesthetic allergies were excluded. After giving intravenous fentanyl (2 μg.kg-1 ), each group received different doses of propofol after 1 or 2 minutes. Non-invasive blood pressure (BP) and heart rate (HR) were measured at pre-induction, pre-intubation, and post-intubation. Time to hypnosis (bispectral index < 60) was also recorded. Results: Of the 192 recruited patients, 186 completed the study (1 min group n = 94; 2 min group n = 92). It was observed that HR and BP decreased after propofol administration and increased after intubation in all groups (p<0.0001). In patients over 55 years, the 2 min - 2 mg.kg-1 group showed the greatest systolic BP reduction (36 ± 12%) at pre-intubation, while the 1 min - 1.5 mg.kg-1 group showed the least hemodynamic alteration between pre- and post-intubation (-4 ± 13%). No significant differences were found in younger patients or in the time to reach hypnosis between the six groups. While no cases of severe bradycardia were recorded, 5,4% of the sample required vasopressors. Conclusion: Increasing the time between the administration of fentanyl and propofol by up to two minutes results in greater hypotension in patients over 55 years.

Anestesia multimodal intratecal en cesáreas, cambios que mejoran su eficacia y seguridad: ensayo clínico / Intrathecal multimodal anesthesia in caesarean sections, changes that improve its efficacy and safety: clinical trial

Resumen: Introducción: la concentración y velocidad en la administración de la anestesia multimodal intratecal con fentanilo en cesáreas mejoran la eficacia anestésica manteniendo buen control hemodinámico. Objetivo: evaluar si algunos cambios en la anestesia multimodal intratecal mejoran su eficacia y seguridad en cesáreas. Material y métodos: ensayo clínico, controlado, aleatorizado, doble ciego en mujeres embarazadas programadas para cesárea, distribuidas en tres grupos: grupo F6B2: fentanilo 65 μg + bupivacaína hiperbárica 2.5 mg + morfina 10 μg + dexmedetomidina 5 μg; grupo F6B3: fentanilo 60 μg + bupivacaína hiperbárica 3 mg+ morfina 100 μg+ dexmedetomidina 5 μg; y grupo F7B2: fentanilo 70 μg + bupivacaína hiperbárica 2 mg + morfina 100 μg + dexmedetomidina 5 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la revisión de correderas parietocólicas y en el postquirúrgico inmediato, así como los signos vitales. Resultados: los grupos F6B2 y F6B3 resultaron tener mayor eficacia anestésica en la revisión de correderas parietocólicas (p = 0.02) y el grupo F7B2 el de mayor seguridad con mejor control hemodinámico a los minutos 1 y 10 (p = 0.03 y p = 0.03 respectivamente). Conclusiones: los cambios en la administración de la anestesia multimodal intratecal con fentanilo mejoraron la eficacia anestésica, pero disminuyen la seguridad sobre el control hemodinámico.

Abstract: Introduction: the concentration and speed in the administration of intrathecal multimodal anesthesia with fentanyl in cesareans section improve anesthetic efficacy while maintaining good hemodynamic control. Objective: to evaluate if some changes in intrathecal multimodal anesthesia improve its efficacy and safety in cesareans section. Material and methods: clinical trial, controlled, randomized, double blind; in pregnant women scheduled for cesarean section, divided into 3 groups: group F6B2: fentanyl 65 μg + hyperbaric bupivacaine 2.5 mg+ morphine 100 μg+ dexmedetomidine 5 μg; group F6B3: fentanyl 60 μg + hyperbaric bupivacaine 3 mg + morphine 100 μg + dexmedetomidine 5 μg; and group F7B2: fentanyl 70 μg + hyperbaric bupivacaine 2 mg + morphine 100 μg + dexmedetomidine 5 μg. The anesthetic efficacy was evaluated prior to the incision, during the dissection of the abdominal wall, upon the admission to the abdominal cavity, in the review of paracolic slides and in the immediate postoperative period, as well as the vital signs. Results: the F6B2 and F6B3 groups turned out to have greater anesthetic efficacy in the revision of paracolic slides (p = 0.02) and the F7B2 group had the highest safety with better hemodynamic control at 1 and 10 minutes (p = 0.03 and p = 0.03, respectively). Conclusions: changes in the administration of intrathecal multimodal anesthesia with fentanyl improved anesthetic efficacy, but decreased safety over hemodynamyc control.

Fentanyl and other New Psychoactive Synthetic Opioids. Challenges to Prevention and Treatment

ABSTRACT Synthetic opioids have played a significant role in the current opioid crisis in the United States (U.S.) and Canada and are a matter of concern worldwide. New psychoactive opioids (NPOs) are classified in the internationally recognized new psychoactive substances (NPSs) category. This group comprises compounds that may have been synthesized decades ago but appeared only recently in the illicit drug market. Such is the case of fentanyl, fentanyl analogs, and non-fentanyl opioids. Most NPOs have effects similar to morphine, including euphoria and analgesia, and can produce fatal respiratory depression. Here, we present an overview of the systemic and molecular effects of main NPOs, their classification, and their pharmacological properties. We first review the fentanyl group of NPOs, including the four compounds of clinical use (fentanyl, alfentanil, sufentanil, and remifentanil) and the veterinary drug carfentanil. We also provide essential information on non-medical fentanyl analogs and other synthetic opioids such as brorphine, etonitazene, and MT-45, used as adulterants in commonly misused drugs. This paper also summarizes the scarce literature on the use of NPOs in Mexico. It concludes with a brief review of the challenges to prevention and treatment posed by NPOs and some recommendations to face them.

Amphetamine-type Stimulants: Novel Insights into their Actions and use Patterns

ABSTRACT This review focuses on the effects and mechanisms of action of amphetamine-type stimulants (ATS) and their adverse effects on the cardiovascular, nervous, and immune systems. ATS include amphetamine (AMPH), methamphetamine (METH, "crystalmeth," or "ice"), methylenedioxymethamphetamine (MDMA, "ecstasy," or "Molly"), MDMA derivatives (e.g., methylenedioxyamphetamine [MDA] and methylenedioxy-N-ethylamphetamine [MDEA]), khat, and synthetic cathinones. The first section of this paper presents an overview of the historical aspects of ATS use, their initial clinical use, and regulations. The second part reviews the acute and chronic impact and the most salient clinical effects of ATS on the central nervous and cardiovascular systems, skin, and mouth. The chemical structure, pharmacokinetics, and classic and non-canonical pharmacological actions are covered in the third section, briefly explaining the mechanisms involved. In addition, the interactions of ATS with the central and peripheral immune systems are reviewed. The last section presents data about the syndemic of ATS and opioid use in the North American region, focusing on the increasing adulteration of METH with fentanyl.

Eficacia y seguridad de la anestesia multimodal intratecal con fentanilo en cesárea: ensayo clínico / Efficacy and safety of multimodal intrathecal anesthesia with fentanyl in cesarean section: clinical trial

Resumen: Introducción: El fentanilo ofrece buena eficacia anestésica, con menores efectos sobre el sistema nervioso simpático, al mantener un mejor estado hemodinámico, pero su efecto en combinación con otros anestésicos en embarazadas no está del todo descrito. Objetivo: Evaluar la eficacia anestésica y seguridad de la anestesia multimodal con fentanilo en mujeres embarazadas durante la cesárea. Material y métodos: Ensayo clínico, controlado, aleatorizado, doble ciego; en mujeres embarazadas programadas para cesárea, distribuidas en tres grupos: grupo FBMD: fentanilo 70 μg + bupivacaína hiperbárica 0.1%, 2 mg, + morfina 100 μg + dexmedetomidina 5 μg; grupo BFM: bupivacaína hiperbárica 0.25%, 5 mg, + fentanilo 25 μg + morfina 100 μg, y el grupo BM: bupivacaína hiperbárica 0.375%, 7.5 mg, + morfina 100 μg. Se evaluó la eficacia anestésica previo a la incisión, durante la disección de la pared abdominal, al ingreso a cavidad abdominal, en la revisión de correderas parietocólicas y en el postquirúrgico inmediato, así como, los signos vitales. Resultados: Se analizaron 180 mujeres. El grupo FBMD mostró mayor eficacia anestésica en la revisión de correderas parietocólicas (p = 0.01) y en el postquirúrgico inmediato (p = 0.0001), así como mayor seguridad con mejor control hemodinámico a los minutos uno y 10 (p = 0.02 y p = 0.03, respectivamente). Conclusiones: La anestesia multimodal con FBMD demuestra mejor eficacia anestésica y seguridad sobre el control hemodinámico.

Abstract: Introduction: Fentanyl offers good anesthetic efficacy and fewer effects on the sympathetic nervous system with better hemodynamic status, but its effect in combination with other anesthetics in pregnant women has not been fully described. Objective: To evaluate the anesthetic efficacy and safety of multimodal anesthesia with fentanyl in pregnant women undergoing caesarean section. Material and methods: Controlled, randomized, double blinded clinical trial; in pregnant women scheduled for cesarean section distributed in 3 groups: FBMD group: fentanyl 70 μg + hyperbaric bupivacaine 0.1%, 2 mg, + morphine 100 μg + dexmedetomidine 5 μg; BFM group: hyperbaric bupivaine 0.25%, 5 mg, + fentanyl 25 μg + morphine 100 μg, and group BM: hyperbaric bupivacaine 0.375%, 7.5 mg, + morphine 100 μg. The anesthetic efficacy was evaluated: prior to the incision, during the dissection of the abdominal wall, upon entry to the abdominal cavity, in the revision of parietocolic slides and in the immediate postoperative period, as well as the vital signs. Results: 180 women were analyzed. The FBMD group showed greater anesthetic efficacy in the revision of parietocolic slides (p = 0.01) and in the immediate postoperative period (p = 0.0001) and greater safety, showing better hemodynamic control at minutes 1 and 10 (p = 0.02 y p = 0.03 respectively). Conclusions: Multimodal anesthesia with FMBD shows better anesthetic efficacy and safety over hemodynamic control.

Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials

Abstract Introduction Spinal infusions of either fentanyl or sufentanil have been reported in international reports, articles, and scientific events worldwide. This study aimed to determine whether intrathecal fentanyl or sufentanil offers safety in mortality and perioperative adverse events. Methods MEDLINE (via PubMed), EMBASE, CENTRAL (Cochrane library databases), gray literature, hand-searching, and clinicaltrials.gov were systematically searched. Randomized controlled trials with no language, data, or status restrictions were included, comparing the effectiveness and safety of adding spinal lipophilic opioid to local anesthetics (LAs). Data were pooled using the random-effects models or fixed-effect models based on heterogeneity. Results The initial search retrieved 4469 records; 3241 records were eligible, and 3152 articles were excluded after reading titles and abstracts, with a high agreement rate (98.6%). After reading the full texts, 76 articles remained. Spinal fentanyl and sufentanil significantly reduced postoperative pain and opioid consumption, increased analgesia and pruritus. Fentanyl, but not sufentanil, significantly reduced both postoperative nausea and vomiting, and postoperative shivering; compared to LAs alone. The analyzed studies did not report any case of in-hospital mortality related to spinal lipophilic opioids. The rate of respiratory depression was 0.7% and 0.8% when spinal fentanyl or sufentanil was added and when it was not, respectively. Episodes of respiratory depression were rare, uneventful, occurred intraoperatively, and were easily manageable. Conclusion There is moderate to high quality certainty that there is evidence regarding the safety and effectiveness of adding lipophilic opioids to LAs in spinal anesthesia.

A randomized comparative study of preoperative fentanyl and dexmedetomidine nebulization on the hemodynamic response to endotracheal intubation

Background: Intense sympathetic activity is linked to laryngoscopy and endotracheal intubation, which could lead to intraoperative problems. We undertook this study to compare the effects of preoperative nebulized Fentanyl and Dexmedetomidine on hemodynamic response to laryngoscopy and endotracheal intubation, taking advantage of their high bioavailability and better absorption through nasal mucosa. Aim and Objectives: The objectives of the study were (i) to compare the effect of preoperative nebulization on the hemodynamic response to laryngoscopy and intubation; and (ii) to assess intraoperative requirement of anesthetic agents. Materials and Methods: This prospective, randomized, and comparative study was conducted among 100 American Society of Anesthesiologists (ASA) I, II patients (of either gender) undergoing elective surgeries and requiring tracheal intubation, were randomized in two groups. Group A was given Fentanyl Nebulization (2 ?g/kg in 4 ml of 0.9% saline) and Group B was given Dexmedetomidine nebulization (1 ?g/kg in 4 ml of 0.9% saline) 10 min before anesthesia induction. Hemodynamic parameters were noted before and immediately after induction, 1 min, 5 min and 10 min after intubation. The main goal was to assess how Fentanyl and dexmedetomidine nebulization affect the laryngoscopy and intubation-induced stress response. The secondary outcome was to assess the intraoperative requirement of anesthetic agents, observe adverse effects of study drug and sedation score. Results: Dexmedetomidine nebulization was found to be more effective in blunting rise in heart rate post laryngoscopy compared to Fentanyl Nebulization (P < 0.0001) as well as in MAP after 10 min of intubation (P < 0.0001). Requirement of propofol was seen to be significantly reduced in Group B compared to Group A (P < 0.05). Sedation scores were significantly higher in Group B (P < 0.05). No evidence of side effects was observed in any group. Conclusion: Nebulisation of dexmedetomidine was found to be more effective in attenuation of stress response of laryngoscopy and intubation compared to nebulisation of fentanyl, with stable intraoperative hemodynamic and no significant side effects.

Comparison of intranasal midazolam-fentanyl with dexmedetomidine–fentanyl as pre-medication in the paediatric age group

Background & objectives: Intranasal midazolam-fentanyl is commonly used as pre-medication in paediatric patients, but there is a risk of respiratory depression with this combination. Dexmedetomidine is a drug that preserves respiratory function. The objective of this study was to compare the efficacy of intranasal midazolam-fentanyl and dexmedetomidine-fentanyl in paediatric patients undergoing elective surgeries. Methods: Hundred children in the age group of 3-8 yr of American Society of Anaesthesiologists physical status grade 1 were randomized into two groups- group A received intranasal midazolam (0.2 mg/kg)-fentanyl (2 ?g/kg) and group B received intranasal dexmedetomidine (1 ?g/kg)-fentanyl (2 ?g/kg) 20 min before induction of general anaesthesia. Heart rate and SpO2 were monitored. Sedation score, parental separation and response to intravenous cannulation were seen after 20 min. Children were monitored for 2 h for post-operative analgesia by Oucher’s Facial Pain Scale. Results: Sedation scores were satisfactory in both groups, although children in group A were more sedated than in group B. Parental separation and response to intravenous cannulation were comparable in both the groups. The two groups were also haemodynamically comparable intraoperatively. Post-operative heart rate was also comparable at all-time intervals in both the groups except for heart rate at 100 and 120 min which were more in group A. Group A experienced more post-operative pain as assessed by Oucher’s Facial Pain Scale as compared to group B. Children receiving intranasal dexmedetomidine- fentanyl had better post-operative analgesia as compared to those who received intranasal midazolam-fentanyl. Interpretation & conclusions: Both intranasal midazolam with fentanyl and intranasal dexmedetomidine with fentanyl provided satisfactory sedation. Both groups were comparable in separation reaction and response to intravenous cannulation with better post-operative analgesia in children receiving intranasal dexmedetomidine-fentanyl.

Comparación de la seguridad de sedoanalgesia entre propofol-fentanilo vs propofol-ketamina en pacientes con covid-19 sometidos a colonoscopias / Comparison of the safety of sedation analgesia between propofol-fentanyl vs propofol-ketamine in COVID-19 patients undergoing colonoscopies

Introducción: Los procedimientos anestésicos fuera de quirófano se han incrementado. Ahora se añade el reto del manejo del paciente con COVID-19, dentro de estos esta la colonoscopia que debe realizarse bajo sedoanalgesia, no se cuenta con un fármaco ideal por lo que se realizan combinaciones para la seguridad del paciente y personal de salud. Objetivo: Comparar la seguridad de sedoanalgesia con propofol-fentanilo vs propofol-ketamina en pacientes con COVID-19 sometidos a colonoscopia. Material y métodos: Se realizó un estudio experimental, transversal, comparativo con 60 pacientes sometidos a colonoscopia, estos fueron seleccionados por sucesión en 2 grupos: grupo A (propofol-fentanil) y grupo B (propofol-ketamina). Grupo A: fentanil 1 ug/kg y posteriormente propofol a 0,5 a 1,5 mg/kg, y mantenimiento con bolos de propofol a 0,5 mg/kg. Grupo B: se preparó mezcla de propofol-ketamina a proporción de 4:1, en la inducción se utilizó propofol (1mg/kg) y ketamina (0,25mg/kg), mantenimiento propofol (5 mg/kg/h) y ketamina (1,25 mg/kg/h). La información fue recolectada de fuentes primarias, se empleó el programa estadístico SPSS versión 22.0. Resultados: El grupo A tuvo tendencia a la bradicardia e hipotensión, además de mayor depresión respiratoria con una frecuencia de 4 (13,3%) en relación a 1 (3,3%) en el grupo ketofol. Conclusión: el ketofol demostró ser más seguro en comparación a propofol- fentanil para la sedoanalgesia en colonoscopia de pacientes COVID-19.

Introduction: Anesthetic procedures outside the operating room have increased. Now the challenge of managing patients with COVID-19 is included, within these is the colonoscopy that must be performed under sedo-analgesia, there is no an ideal drug so combinations are made for the safety of the patient and the health staff. Objective: To compare the safety of sedo-analgesia with propofol-fentanyl vs propofol-ketamine in patients with COVID-19 undergoing colonoscopy. Material and methods: An experimental, cross-sectional, comparative study was carried out in 60 patients submitted to colonoscopy, these were selected by succession into 2 groups: group A (propofol-fentanyl) and group B (propofol- ketamine). Group A: fentanyl 1 ug/kg and later propofol at 0.5 to 1.5 mg/kg, and maintenance with propofol boluses at 0.5 mg/kg. Group B: a mixture of propofol- ketamine was prepared at a ratio of 4:1, in induction propofol (1 mg/kg) and ketamine (0.25 mg/kg) were used, propofol maintenance (5 mg/kg/h) and ketamine (1.25 mg/ kg/h). The information was collected from primary sources, the statistical program SPSS version 22.0 was used. Results: Group A had a tendency to bradycardia and hypotension, as well as greater respiratory depression with a frequency of 4 (13.3%) in relation to 1 (3.3%) in the ketofol group. Conclusion: Ketofol has shown to be safer compared to propofol-fentanyl for colonoscopy sedo-analgesia in COVID-19 patients.

Progress of relationship between fentanyl family and immunomodulation / 肿瘤研究与临床

The abuse of opioids in the perioperative period has made the side effects of opioids increasingly prominent. So many anesthesiologists have proposed the concept of opioid-free anesthesia. Immunomodulation is an important field of modern medical research. With the introduction of the concept of enhanced recovery after surgery, the immunomodulatory effects of opioids have received increasing attention. Currently, the fentanyl family is commonly used opioid analgesics in clinical practice. This article reviews the research progress of the fentanyl family and immunomodulation, in order to provide guidance for clinicians to choose analgesic drugs.

Effect of gender on anesthetic potency of ciprofol for gastroscopy when combined with fentanyl / 中华麻醉学杂志

Objective:To evaluate the effect of gender on anesthetic potency of ciprofol for gastroscopy when combined with fentanyl.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-50 yr, with body mass index of 18-25 kg/m 2, undergoing elective gastroscopy with intravenous anesthesia, were divided into 2 groups according to gender: male group (M group) and female group (F group). After fentanyl 1.5 μg/kg was intravenously injected, ciprofol was given by the Dixon′s up-and-down method, with the initial dose of 0.4 mg/kg followed by dose increment/decrement of 0.04 mg/kg. The ED 50 and 95% confidence interval of ciprofol for gastroscopy anesthesia were calculated by the probit regression analysis. Results:The ED 50 (95% confidence interval) of ciprofol for gastroscopy was 0.33 (0.32-0.34) mg/kg in F group and 0.27 (0.26-0.28) mg/kg in M patients when combined with fentanyl 1.5 μg/kg. There was no significant difference between the two groups ( P>0.05). Conclusions:There is no significant gender difference in the anesthetic potency of ciprofol for gastroscopy (ED 50: female 0.33 mg/kg, male 0.27 mg/kg) when combined with fentanyl (1.5 μg/kg).

Research Progress on Machine Learning Assisted Non-Targeted Screening Strategy for Identification of Fentanyl Analogs / 法医学杂志

In recent years, the types and quantities of fentanyl analogs have increased rapidly. It has become a hotspot in the illicit drug control field of how to quickly identify novel fentanyl analogs and to shorten the blank regulatory period. At present, the identification methods of fentanyl analogs that have been developed mostly rely on reference materials to target fentanyl analogs or their metabolites with known chemical structures, but these methods face challenges when analyzing new compounds with unknown structures. In recent years, emerging machine learning technology can quickly and automatically extract valuable features from massive data, which provides inspiration for the non-targeted screening of fentanyl analogs. For example, the wide application of instruments like Raman spectroscopy, nuclear magnetic resonance spectroscopy, high resolution mass spectrometry, and other instruments can maximize the mining of the characteristic data related to fentanyl analogs in samples. Combining this data with an appropriate machine learning model, researchers may create a variety of high-performance non-targeted fentanyl identification methods. This paper reviews the recent research on the application of machine learning assisted non-targeted screening strategy for the identification of fentanyl analogs, and looks forward to the future development trend in this field.

Analgosedación con propofol y fentanilo en las colonoscopia / Analgosedation with propofol and fentanyl in colonoscopy

Introducción: La comodidad durante la colonoscopia es una condición importante si se quiere que el paciente acepte procedimientos repetidos. Por lo tanto, se necesita de una buena sedación que pudiera combinar la analgesia con amnesia. Objetivo: Describir la utilidad de la analgosedación balanceada con propofol/fentanilo en colonoscopia ambulatoria. Métodos: Se realizó un estudio observacional descriptivo longitudinal prospectivo en pacientes a los que se les realizó colonoscopia de forma ambulatoria en el Hospital General Universitario Dr. Gustavo Aldereguía Lima en el período entre enero de 2017 y diciembre de 2018. Resultados: El 34,2 por ciento de los pacientes tenía entre 50 y 59 años, el 62,9 por ciento eran mujeres. El 73,3 por ciento de los pacientes se clasificó como ASA II según el estado físico. Los valores medios de frecuencia cardiaca y tensión arterial media tuvieron una disminución ligera después de aplicada la anestesia y se mantuvieron constantes en el resto de los momentos evaluados. Los valores medios de saturación de oxígeno de la hemoglobina se mantuvieron relativamente constantes en todos los momentos y resultaron algo superiores a la llegada del paciente a recuperación. La calidad de la sedación fue adecuada en 86,2 por ciento de los pacientes. La calidad de la analgesia y la recuperación fue buena en 88,4 por ciento y 96,2 por ciento , respectivamente. Se presentaron complicaciones en el 16,5 por ciento de los pacientes. Conclusiones: La analgosedación con propofol y fentanilo resultó una alternativa anestésica de utilidad en los pacientes a los que se les realizó colonoscopia ambulatoria con gran estabilidad hemodinámica en la serie estudiada(AU)

Introduction: Comfort during colonoscopy is an important condition if the patient is expected to accept repeated procedures. Therefore, good sedation that could combine analgesia with amnesia is needed. Objective: To describe the usefulness of balanced analgosedation with propofol/fentanyl in outpatient colonoscopy. Methods: A prospective, longitudinal, descriptive and observational study was carried out with patients who received outpatient colonoscopy at Dr. Gustavo Aldereguía Lima General University Hospital in the period between January 2017 and December 2018. Results: 34.2 percent of the patients were between 50 and 59 years old, while 62.9 percent were women. 73.3 percent of patients were classified as ASA II, according to their physical status. The mean values for heart rate and mean arterial blood pressure had a slight decrease after anesthesia was applied and remained constant for the rest of the evaluated times. The mean values of hemoglobin-oxygen saturation remained relatively constant at all the evaluated times and were slightly higher on the patient's arrival to recovery. The quality of sedation was adequate in 86.2 percent of the patients. The quality of analgesia and recovery was good in 88.4 percent and 96.2 percent, respectively. Complications occurred in 16.5 percent of the patients. Conclusions: Analgosedation with propofol and fentanyl proved to be a useful anesthetic alternative in patients undergoing outpatient colonoscopy, with high hemodynamic stability in the studied series(AU)

To Compare the effect of Chloroprocaine and Chloroprocaine with Fentanyl for Spinal Anaesthesia: A Prospective Randomised Double Blind Study.

Background: Usually for lower abdomen and lower limb short surgical procedures, spinal anaesthesia is a reliable and safe anaesthesia technique.2-chloroprocaine (2-CP) is an amino-ester local anaesthetic with a very short half-life. Adjuvants are required with short acting local anaesthetic for spinal anaesthesia to prolong analgesia. Aims and Objectives: The present study was conducted to analyse the effect of 2-CP alone and with fentanyl combination in spinal anaesthesia for short surgical procedures in terms of onset of block, adequacy of anaesthesia, analgesia and recovery. Materials and Methods: The study was conducted in our hospital in 60 patients undergoing lower abdomen and lower limb short surgical procedures under spinal anaesthesia with either 2-CP or 2-CP and fentanyl (group I or group II) after randomisation into two groups. Spinal anaesthesia characteristics of sensory and motor block, duration of analgesia were noted and appropriate statistical analysis was performed. Results: The onset of sensory and motor block was faster in group II[5.00 ± 3.19 vs 7.156 ± 3.38 min. (p= 0.0138) and 8.03 ± 5.65 vs 11.03 ± 3.97 min. (p= 0.021)] than in group I, and duration of effective analgesia was prolonged in group II (147.63 ± 40.71 vs 130.40 ± 50.85 min with p value of 0.0002)as compared to group I. Eleven patients in group I required analgesic supplementation in the intraoperative period. Conclusion: The patients undergoing short surgical procedures of lower abdomen and lower limb under spinal anaesthesia with short acting local anaesthetic 2-CP with fentanyl as an additive provides rapid onset of sensory and motor block and prolonged duration of analgesia.

Clinical Comparative Evaluation of Bupivacaine with Fentanyl and Ropivacaine with Fentanyl in Upper Limb Surgery Under Supraclavicular Brachial Plexus Block

Introduction: A lot of surgeries are now performed to reduce a number of physical ailments. Although these surgeries are done to reduce the sufferings these inevitably lead to a lot of pain for the patient. Material and Methods: Our study comprises of 60 patients who had undergone elective upper limb surgery in a tertiary care centre of central India. Patients of both genders, in age group 18-60 years with American Society of Anaesthesiology (ASA) grade I or II were included in our study and divided in two groups of 30 each. Results: Data was entered into MS-Excel sheet and analysed by SPSS version 20. Quantitative data was compared by using student t-test and qualitative data by using chi-square test and Fisher exact test, as applicable. P<0.05 was considered as statistically significant. Both the groups were similar in demographic and surgical characteristics. However, we found that the group given bupivacaine and fentanyl had longer duration of sensory and motor block and post-operative analgesia than ropivacaine and fentanyl group (p<0.001). Conclusion: Combination of bupivacaine with fentanyl provides longer duration of sensory block, motor block and postoperative analgesia without any major side effects than combination of ropivacaine with fentanyl with comparable haemodynamic in both groups.

Comparison of Two Drug Combinations in Total Intravenous Anaesthesia: Propofol-Ketamine and Propofol-Fentanyl

Introduction: TIVA has many advantages over inhalational anaesthesia such as minimal cardiac depression, decreased oxygen consumption, avoids postoperative diffusion hypoxemia, decreases the incidence of postoperative nausea and vomiting etc. This study was conducted to evaluate and compare two TIVA drug combinations using propofol- ketamine and propofol-fentanyl, and to examine the characteristics of induction of anaesthesia, maintenance, and recovery. Method: 34 patients of ASA grading 1,2 and 3 aged between 20 to 65 years of either sex undergoing short surgical procedures were included in the study. According to Comparison of systolic blood pressure of both the groups at intubation time of anaesthesia in group I and group II. Patients in group I received propofol and ketamine intravenously (IV) to induce anaesthesia. For group II, fentanyl and propofol were administered as IV bolus doses. All the results were tabulated and analyzed statistically. Result: Propofol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressures as compared to propofol-ketamine during induction of anaesthesia. Propofol-ketamine combination produced stable hemodynamic during maintenance phase while on the other hand propofol-fentanyl was associated with a slight increase in both PR and BP. During recovery, ventilation score was better in group I while movement and wakefulness score was better in group II. Conclusions: Both propofol-ketamine and propofol-fentanyl combinations produce rapid, pleasant and safe anaesthesia with only a few untoward side effects and only minor hemodynamic effects.

A comparative study of intraperitoneal Bupivacaine with Dexmedetomidine versus intraperitoneal Bupivacaine with Fentanyl for post operative analgesia following laparoscopic cholecystectomy

INTRODUCTION: Maximum open surgeries are being replaced with laparoscopic surgeries. Laparoscopic cholecystectomy is being more commonly prac?ced than open surgery. Many parenteral or oral medica?ons are used to control post opera?ve pain following laparoscopic cholecystectomy do have their own side effects. So, local ins?lla?on will be beneficial with lesser or negligible side effects. The present study was conducted to compare the effect of intraperitoneal ins?lla?on of 0.25% Bupivacaine with Dexmedetomidine and 0.25% Bupivacaine with Fentanyl to know which combina?on has be?er efficacy in pa?ents of Laparoscopic Cholecystectomy. METHODOLOGY: The present compara?ve study was carried on pa?ents posted for Laparoscopic Cholecystectomy in a ter?ary care hospital during 2019 to 2022, The pa?ents were divided in two equal groups of 40 each with Group D - Pa?ents receiving 0.25% bupivacaine with Dexmedetomidine and were ins?lled with 30ml of 0.25% bupivacaine with 1 µg/kg Dexmedetomidine (diluted in 2 ml Normal Saline). Also, Group F - Pa?ents receiving 0.25% bupivacaine with Fentanyl where pa?ents were ins?lled with 30ml of 0.25% bupivacaine with 1 µg/kg Fentanyl (diluted with 2 ml Normal saline NS). Degree of postopera?ve pain was assessed using Visual Analogue Scale (VAS). RESULTS: Overall VAS in 24 hrs was significantly lower in the D group compared to F group. The ?me required for the first dose of rescue analgesia was longer in the D group than in F group, indica?ng be?er and longer pain relief in the D group compared to that of F group. The difference was also sta?s?cally significant among the two groups. Total analgesic consump?on was high in F group than in the D group. CONCLUSION: We concluded that intraperitoneal ins?lla?on of dexmedetomidine 1 µg/kg in combina?on with 0.25% Bupivacaine in elec?ve laparoscopic cholecystectomy significantly reduces the post opera?ve pain and analgesic requirement in postopera?ve period.

Efficacy of epidural 0.25 ml fentanyl versus 0.5 ml dexmedetomidine with 0.75% ropivacaine in lower abdominal surgeries

Background: Epidural anesthesia alloyed with opioids facilitates a dose sparing effect of local anesthetic and superior analgesia. The drugs such as dexmedetomidine and fentanyl are effective adjuvants to ropivacaine to provide efficient post-operative analgesia. Still, the findings are contradictory. Aims and Objectives: The aims of the study were to assess the efficacy of 0.75% ropivacaine with 0.25 ml fentanyl and 0.5 ml dexmedetomidine in the patients undergoing lower abdominal surgeries. Materials and Methods: A total of 80 cases undergoing lower abdominal surgeries above 21 years were recruited. Group RF administered with 18ml of 0.75% ropivacaine + 0.25 ml fentanyl. Group RD administered with 18ml of 0.75% ropivacaine + 0.5 ml dexmedetomidine. During intraoperative period, parameters such as sensory block, motor block by modified Bromage scale, pain score, and hemodynamic parameters were recorded. The sedation score was assessed using Ramsay sedation score. Results: The mean difference of the events of sensory block and motor block between two study groups was statistically significant (P < 0.05). The mean systolic blood pressure (SBP) was comparatively less in Group RD than Group RF during the entire study period. The mean difference of SBP, heart rate, and mean arterial pressure was statistically significant (P < 0.05). Preoperatively, the diastolic blood pressure was higher in Group RD; later stages, the levels were lesser than Group RF. The mean sedation score was less in Group RD till 15 min, later, it was higher in Group RD than Group RF. Bradycardia was commonly associated post-operative complication in both the study groups followed by nausea and vomiting. Conclusion: The fentanyl and dexmedetomidine are effective adjuvants to ropivacaine. However, dexmedetomidine has better efficacy in terms of prolonged duration of sensory block, motor block, and postoperative analgesia, minimal requirement of rescue analgesia and with less post-operative complications.

Comparison of onset of action of Intrathecal Clonidine vs Intrathecal Fentanyl as an adjuvant with hyperbaric Bupivacaine and Bupivacaine alone under spinal anesthesia for lower limb orthopedic surgeries

Background: Adjuvants are added to a local anesthetic solution to prolong the duration of analgesia. There is a paucity of studies comparing the onset of action of adjuvants like Clonidine and Fentanyl. In this study, the time of onset of action of intrathecal clonidine and intrathecal fentanyl as adjuvants to bupivacaine and bupivacaine alone were compared in the subarachnoid block for lower limb orthopedic surgeries. Materials and Methods: 90 adult patients posted for orthopedic surgery of the lower limb were divided into three equal groups of 30 each. Group A being the control group was given hyperbaric Bupivacaine(3ml) +0.5ml of Normal saline, Group B was given Intrathecal hyperbaric Bupivacaine (3 ml) +30 ?g Clonidine and Group C was given Intrathecal hyperbaric Bupivacaine (3 ml) + Fentanyl 25 ?g. The primary objective was to compare the time of onset of block and duration of analgesia. The secondary outcomes were the duration of sensory and motor block, duration of analgesia, hemodynamic parameters, and side effects. Results: The time of onset of the sensory blockade was 4.83 ± 0.64, 1.72 ± 1.47, and 3.4 ± 1.43 mins in groups A, B, and C respectively. The time of onset of the motor blockade as estimated by the time to reach level 2 on the Bromage scale, was 6.07 ± 0.55, 2.38 ± 1.32, and 5.06 ± 1.28 mins in groups A, B, and C respectively. The duration of postoperative analgesia was prolonged in the Clonidine group compared to the Fentanyl group. Conclusion: The study reveals that the time of onset of action of sensory and motor block was faster and the duration of analgesia was prolonged with adjuvants like Clonidine when compared to Fentanyl when added to Bupivacaine.