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PubMed1992

[Etomidate modifies hemodynamic response to fentanyl in patients with impaired left ventricular function].

The haemodynamic effects and the side-effects of anaesthesia using high doses of fentanyl were compared in two groups of 12 patients each. All the patients had poor left ventricular function and were scheduled for elective coronary artery bypass graft surgery or valvular replacement. Patients were randomly assigned to either group. In group EF, patients were given 5 micrograms.kg-1 of fentanyl, followed by 0.3 mg.kg-1 of etomidate. Once they had lost consciousness, they were given 15 mg of pancuronium and 25 micrograms.kg-1 of fentanyl over a 5 min period. Patients in group F received the full 30 micrograms.kg-1 dose of fentanyl over a 5 min period, followed by 15 mg of pancuronium. The patients were intubated 2 min after the end of the fentanyl infusion. They were mechanically ventilated with 100% oxygen. Anaesthesia was maintained with a continuous infusion of fentanyl (total dose 100 micrograms.kg-1). The usual haemodynamic parameters were monitored and calculated, as well as pain during injection of the drugs, myoclonia, chest wall rigidity and the time to loss of consciousness. The two groups were comparable with respect to age, weight, height and surgery. One third of the patients in group EF complained of pain during etomidate injection. The time required to loose consciousness was shorter in group EF (55 +/- 16 sec) than in group F (177 +/- 56 sec) (p < 0.001). The cardiac index decrease in group EF (2.0 +/- 0.4 l.min-1.m-2 vs. 1.9 +/- 0.4 l.min-1.m-2) (p < 0.05), respectively between the time just before tracheal intubation (T1), and 10 min after tracheal intubation (T3).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed1988

[Hemodynamic effects of fentanyl and sufentanil combined with flunitrazepam in coronary artery surgery].

Because sufentanil has been reported as being able to prevent or treat peroperative hypertensive crises during aorto-coronary artery graft surgery, a study was carried out to compare the haemodynamic effects of sufentanil with those of fentanyl. 20 patients who were to undergo aortocoronary bypass grafting (CABG) were randomly allocated to two equal groups, sufentanil (Sf) and fentanyl (F) groups. A 1 to 5 dose ratio was used so as to have equipotent doses of sufentanil and fentanyl. Induction doses were 10 micrograms.kg-1 sufentanil and 50 micrograms.kg-1 fentanyl. Up to 20 micrograms.kg-1 sufentanil and 100 micrograms.kg-1 fentanyl were then used between intubation and the setting-up of cardiopulmonary bypass (CPB). A bolus of 10 micrograms.kg-1 flunitrazepam was given if necessary, so as to lower the mean arterial pressure (Pa) to below 100 mmHg after intubation, and under 80 mmHg during CPB. Heart rate, Pa, mean pulmonary arterial pressure, pulmonary wedge pressure (Ppw), central venous pressure and cardiac output were measured before anaesthesia, 2 min after intubation, before incision, 2 min after sternotomy, 10 min after the end of CPB, after chest closure, 30 min and 2h after arrival of the patient in the intensive care unit. The only difference found between the two groups was a more rapid drop in left ventricular preload after induction with sufentanil; 2 min after intubation, there was a 26% fall in Ppw with sufentanil (p less than 0.01) and 8% with fentanyl. Before skin incision, this drop was of 32% (p less than 0.01) and 24% (p less than 0.01) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2001

Long-term observations of patients receiving transdermal fentanyl after a randomized trial.

We observed 73 cancer patients receiving transdermal fentanyl for 1-29 (mean 5.5) months immediately after participation in a randomized clinical trial. Of these, 32 received fentanyl until death, 18 were lost to follow-up, 11 required alternative analgesia, and 12 withdrew for other reasons. The median first recorded dose (not necessarily the patient's first fentanyl dose) was 75 microg/h. The median final dose was 100 microg/h. All but 3 patients required <300 microg fentanyl/h. In the 16 who received fentanyl for > or =3 months until death, the median dose was unchanged (100 microg/h) 3 months before death and at death; 8/16 required no dosage change. The incidence of constipation, skin reactions, nausea, and vomiting was low. No significant respiratory depression was associated with fentanyl. Most patients (85%) and investigators (86%) rated the treatment as good or excellent. We conclude that long-term treatment with transdermal fentanyl is safe and acceptable to many cancer patients.

Administration, Cutaneous↗
PubMed1998

Fentanyl by continuous subcutaneous infusion for the management of cancer pain: a retrospective study.

Twenty-two patients who received fentanyl by continuous subcutaneous infusion for treatment of cancer pain were evaluated retrospectively. No local toxicities were noted. Five patients were switched from transdermal fentanyl due to uncontrolled pain; three achieved stability, accompanied by improvement in visual analogue scores for pain. Seventeen patients were switched from other opioids due to toxicity; 10 achieved stability, with documented improvement in toxicity in seven. The median dose ratio of opioid prior to switchover (mg/day) to fentanyl at stabilization (mg/day) was 85.4 (range 65-112.5) for morphine and 23.0 (range 10.7-29.7) for hydromorphone. Of six stable patients switched from subcutaneous to transdermal fentanyl, four maintained stability. We conclude that fentanyl by continuous subcutaneous infusion is a useful alternative for cancer patients who experience uncontrolled pain while receiving transdermal fentanyl or who experience toxicity on other opioids.

Aged↗
PubMed1999

A comparison of subcutaneous morphine and fentanyl in hospice cancer patients.

This study compares subcutaneous (s.c.) morphine and fentanyl with respect to pain control and side effects using a 6-day randomized, double-blind, cross-over design. Results were obtained from 23 patients (12 males and 11 females: mean age of 70.5 years) who could tolerate morphine. Thirteen patients were randomized to receive morphine for the first 3 days followed by fentanyl; 10 received fentanyl first followed by morphine. There were no significant differences in the scores for pain between the two drugs, suggesting that fentanyl is equally efficacious and the conversion ratio of morphine 10 mg: fentanyl 150 micrograms is appropriate. Patients had more frequent bowel movements during days 4-6 while on the fentanyl arm [t-test, df (22), P = 0.015]. Other measures for nausea, delirium, and cognitive function showed no differences between the two drugs. This study highlights the need to further assess the role of various opioids in hospice patients, and emphasizes the requirement for sensitive and simple cognitive tests in this population.

Aged↗
PubMed1989

Lumbar epidural fentanyl analgesia after thoracic surgery.

Thoracic epidural fentanyl has been used successfully for postoperative analgesia in patients undergoing thoracic surgery. Prior investigators have suggested that increasing the administered dosage and volume of lumbar epidural fentanyl may increase the spread of analgesia. The feasibility of injecting a high volume (20 mL) of fentanyl into the lumbar epidural space for post-thoracic surgery analgesia was studied in 17 patients undergoing elective thoracotomy or sternotomy. All patients had a lumbar epidural catheter placed before induction of general anesthesia. No narcotic was administered during surgery. Thirty minutes before the conclusion of anesthesia, 200 micrograms of fentanyl in 16 mL of 0.9% saline was administered via the epidural route. In the intensive care unit (ICU), additional fentanyl in the same dosage and volume was injected when the patient complained of pain. Pain was scored on a linear analog scale pre-injection and 30 minutes post-injection. Arterial blood gases were obtained simultaneously. All patients experienced pain relief within 15 minutes of injection. No significant respiratory depression or hypercarbia was noted. Lumbar epidural fentanyl is a safe and practical alternative to thoracic epidural analgesia in the post-thoracic surgical patient.

Adolescent↗
PubMed2002

A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study.

STUDY OBJECTIVE: To compare the frequency of adverse effects of remifentanil and fentanyl in a large and diverse patient population. DESIGN: Prospective, randomized, open-label study. SETTING: Multicenter study including academic and community hospitals. PATIENTS: 2,438 adult patients (1,496 outpatients and 942 inpatients) scheduled for elective surgical procedures under general endotracheal anesthesia of at least 30-minute duration. INTERVENTIONS: Patients were randomly assigned to receive either intravenous (IV) remifentanil (n = 1,229) 0.5 microg/kg/min for induction and tracheal intubation followed by an infusion rate of 0.25 microg/kg/min or fentanyl (n = 1,209) administered according to the anesthesiologist's usual practice. Anesthesia was maintained with propofol and/or isoflurane (with or without nitrous oxide) titrated according to protocol. Transition analgesia with either morphine or fentanyl was administered in the remifentanil and, at the anesthesiologist's discretion, in the fentanyl group. MEASUREMENTS: The overall nonspecific and specific (i.e., opioid-related) adverse effects were recorded. MAIN RESULTS: Remifentanil was associated with more intraoperative hypotension than fentanyl (p < 0.05). All four cases (0.3%) of muscle rigidity occurred in the remifentanil-treated outpatients. There were no significant differences between the two drugs with respect to other adverse events (i.e., episodes of hypertension, bradycardia, respiratory depression, and apnea). CONCLUSIONS: In the doses used, both remifentanil and fentanyl have a similar frequency of adverse effects except for the higher frequency of hypotension associated with the use of remifentanil.

Adult↗
PubMed1996

Changes in heart rate variability during induction of anesthesia with fentanyl and midazolam.

OBJECTIVE: The study was designed to evaluate changes in autonomic nervous system function during induction of anesthesia with fentanyl, midazolam, and pancuronium and to answer the question of dose-dependency of these effects. DESIGN: Prospective, randomized. SETTING: A university hospital. PARTICIPANTS: Forty consecutive cardiac surgical patients. INTERVENTIONS: Anesthesia was induced with fentanyl, midazolam, and pancuronium. The patients were assigned to four groups differing in dosages of fentanyl plus midazolam and speed of injection. Fentanyl, 7.5 micrograms/kg (group A), 12.5 micrograms/kg (group B), and 20.0 micrograms/kg (group C) plus midazolam, 0.075 mg/kg (group A), 0.125 mg/kg (group B), and 0.200 mg/kg (group C) were administered over 10 minutes; in group D, fentanyl, 7.5 micrograms/kg, and midazolam, 0.075 mg/kg, were administered within 1 minute. MEASUREMENTS AND MAIN RESULTS: Heart rate variability (HRV) was measured using parameters in the time domain and the frequency domain. The comparison of preinduction HRV with the intra-anesthetic epochs did not show significant differences with respect to heart rate, coefficient of variation, and root mean squared successive differences. Spectral analysis showed significant reductions of power in the vasomotor band (0.01 to 0.05 Hz) and the low-frequency band (0.05 to 0.15 Hz) in all groups. Power in the high-frequency band (0.15 to 0.50 Hz) decreased slightly, but this did not reach the significance level. A dose dependency of these changes was found in the low-frequency band only. CONCLUSIONS: Parameters of HRV suggest that induction with fentanyl, midazolam, and pancuronium decreases sympathetic but not parasympathetic autonomic system activity. The anesthetic induction technique's modulation of autonomic nervous system balance is better represented by means of spectral analysis than by analysis in the time domain. This modulation was largely independent of the doses administered and independent of the speed of injection.

Adult↗
PubMed1998

Propofol-based versus fentanyl-isoflurane-based anesthesia for cardiac surgery.

OBJECTIVE: To evaluate drug costs, time of mechanical ventilation, complications, and hospital length of stay comparing propofol-based with fentanyl-isoflurane-based anesthesia. DESIGN: A prospective, randomized study. SETTING: A university-affiliated, tertiary care community hospital. PARTICIPANTS: Seventy patients undergoing primary coronary artery bypass surgery. INTERVENTIONS: Patients were randomized to either a low-dose fentanyl-isoflurane or a lower-dose fentanyl-isoflurane anesthetic supplemented with a continuous infusion of propofol. MEASUREMENTS AND MAIN RESULTS: Fentanyl-isoflurane anesthesia was significantly less expensive ($50.03+/-$27.26 v $121.69+/-$31.40) for anesthesia drugs and ($58.08+/-$27.39 v $129.91+/-$31.52) for total drug costs. There was also a trend for patients in the fentanyl-isoflurane group to be extubated slightly sooner (388+/-202 v 449+/-252 min) and go home sooner (5.1+/-1.8 v 6.0+/-3.0 days). CONCLUSION: Fentanyl-isoflurane provides an inexpensive anesthetic that permits as prompt an extubation as propofol, thus conserving resources for other patients.

Anesthesia, General↗
PubMedDate not supplied

Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery.

BACKGROUND AND OBJECTIVES: Visceral pain decreases in cesarean patients under spinal anesthesia when the dose of local anesthetic is increased. However, larger doses of local anesthetic are associated with higher sensory blocks. We hypothesized that the addition of fentanyl could reduce the dose of bupivacaine necessary to achieve adequate surgical anesthesia. METHODS: Two double-blinded, sequential, prospective studies were performed on 120 patients. In the preliminary study, the patients received 8, 10, or 12 mg of 0.5% hyperbaric bupivacaine intrathecally. In the second, main study, they received each bupivacaine dose with 10 microg of fentanyl. Each group consisted of 20 patients, and the groups were identified as B8, B10, B12, BF8, BF10, and BF12. Sensory and motor block, intraoperative pain defined by visual analogue scale (VAS), muscle relaxation, and side effects were assessed. We also measured the sensory and motor recovery and the onset of pain in the postanesthesia care unit (PACU). RESULTS: Maximal block level and incidence of high block (> or = T1) were higher in the 12-mg groups. There was intraoperative pain in 35% of the B8 patients and 20% of the B10 patients, but none in the B12 patients and all fentanyl groups. Incidences of other side effects were not different. The addition of fentanyl to bupivacaine significantly delayed the onset of postoperative pain and sensory recovery, but motor recovery time did not change with additional fentanyl. CONCLUSIONS: The optimal dose of hyperbaric bupivacaine to produce surgical anesthesia was 12 mg, which was accompanied by high sensory block. With the addition of 10 microg of fentanyl, the dose of bupivacaine could be reduced to 8 mg in spinal anesthesia for cesarean delivery.

Adjuvants, Anesthesia↗
PubMed2002

Fentanyl added to bupivacaine 0.05% or ropivacaine 0.05% in patient-controlled epidural analgesia in labour.

BACKGROUND AND OBJECTIVE: Epidural analgesia is the most effective method for pain relief during labour. The aim was to elucidate the efficacy of ropivacaine 0.05% and bupivacaine 0.05%, which were both combined with fentanyl 0.00015% to provide analgesia in labour. METHODS: Forty nulliparous females were enrolled into the study. After insertion of an epidural catheter, patients were randomly assigned into two groups. Once the os uteri had dilated to 4-5 cm, a bolus of bupivacaine 0.125% 10mL + fentanyl 50 microg (1 mL) in Group 1 patients, and ropivacaine 0.125% 10mL + fentanyl 50 microg (1 mL) in Group 2 patients was administered via the epidural catheter. Then, patient-controlled epidural analgesia was started with a basal infusion of bupivacaine 0.05% 10 mLh(-1) + fentanyl 0.00015% 1.5 pgmL(-1) in Group 1, and ropivacaine 0.05% + fentanyl 1.5 microgmL(-1) in Group 2. When needed, a 10 mL bolus infusion could be given and the lockout time was 20 min. Maternal and fetal haemodynamic variables were monitored before induction and subsequently at 5 min intervals. Using a visual analogue scale assessed the degree of pain. RESULTS: Maternal haemodynamic variables and Apgar scores were not different between the two groups. The second stage of the labour was shorter in Group 2 (P < 0.01). There were no significant differences in patients' assessment of motor block or mode of delivery between groups. CONCLUSIONS: An epidural infusion (10 mLh(-1)) of bupivacaine 0.05% or ropivacaine 0.05% together with fentanyl 1.5 microg mL(-1) provided good and safe analgesia during labour.

Adult↗
PubMed2002

Comparison of the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate.

BACKGROUND AND OBJECTIVE: This prospective, randomized, double-blinded study was designed to compare the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate. METHODS: Seventy-two patients were enrolled in six groups of 12 individuals each. In three groups, fentanyl was given as a bolus dose of 1.5 microg kg(-1), whereas the others received a remifentanil infusion at 0.5 microg kg(-1) min(-1). Five minutes later, propofol, thiopental or etomidate were titrated to a state of unresponsiveness. Assessment included the amounts of drug necessary for induction, haemodynamics and the times to apnoea, loss of eyelash reflex, and the release of a water-filled syringe held in the patient's hand. RESULTS: Induction times to loss of the eyelash reflex were significantly shorter in the remifentanil than in the fentanyl groups: with propofol 50.7 +/- 13.6s (mean +/- SD) versus 74.9 +/- 27.0s (P < 0.01), with thiopental 42.9 +/- 16.8s versus 77.2 +/- 27.8s (P < 0.01) and with etomidate 54.7 +/- 17.6s versus 72.3 +/- 24.0s (P < 0.05). The times to respiratory arrest or for the syringe to fall were significantly shorter with remifentanil than with fentanyl for propofol and for thiopental, but not for etomidate. In terms of dosages per kg body weight necessary to achieve unresponsiveness, less propofol (-29%, P < 0.05), thiopental (-25%, P < 0.05) or etomidate (-32%, P < 0.01) was necessary with remifentanil than with fentanyl. Haemodynamic responses to tracheal intubation were controlled more effectively with remifentanil. However, within the remifentanil groups, mean arterial pressure significantly decreased during induction: -26% with propofol, -181% with thiopental and -14% with etomidate (all P < 0.01). CONCLUSIONS: During anaesthetic induction, a remifentanil infusion of 0.5 microg kg(-1) min(-1) over 5 min is a suitable alternative to a 1.5 microg kg(-1) bolus dose of fentanyl: induction times are shorter with reduced amounts of propofol, thiopental or etomidate.

Adult↗
PubMed2002

Epidural bupivacaine with sufentanil or fentanyl during labour: a randomized, double-blind study.

BACKGROUND AND OBJECTIVE: Epidural analgesia with bupivacaine plus either sufentanil or fentanyl is widely used during labour, but it is not clear which opioid is to be preferred. The study compared these opioids at equianalgesic doses in terms of analgesia, onset time and side-effects. METHODS: Ninety females in active labour were entered into the randomized, double-blind trial. A test dose of bupivacaine was given into the epidural space. Parturients in Group S received sufentanil 8 mL as a bolus dose, followed by an infusion at a rate of 5 mL h(-1) of a mixture containing sufentanil 1 microg mL(-1) and bupivacaine 1 mg mL(-1). Patients in Group F received fentanyl 8 mL as a bolus, followed by an infusion at 5 mL h(-1) of a solution containing fentanyl 3.5 microg mL(-1) and bupivacaine 1 mg mL(-1). Additional boluses of 5 mL were of the relevant solution were given if necessary. RESULTS: In a ratio of 1.0:3.5 (sufentanil 1 microg versus fentanyl 3.5 microg), both groups reported the same analgesia with the same onset time. The onset time to obtain 50% of the initial visual analogue score was 10 and 11 min for Groups S and F, respectively. Mean visual analogue scores in Groups S and F respectively declined from 77 and 82 before epidural blockade, to 29 and 27 during the first stage of labour, and to 69 and 59 respectively during the second stage. Overall satisfaction among parturients was high (98 and 96%), particularly during the first stage (98 and 98%), and also to a large degree during the second stage of labour (74 and 79%). Furthermore, only a few extra bolus doses were required (mean 0.9 and 1.2, Groups S and F, respectively). All the females could stand on their own, and almost all (81% Group S; 79% Group F) could walk 20 m without help. There were no serious adverse effects. Moderate side-effects occurred equally often with the possible exception of less nausea and vomiting in the fentanyl group. CONCLUSIONS: Epidural analgesia for ambulatory parturients with bupivacaine plus either sufentanil or fentanyl (ratio 1.0:3.5) provides good analgesia with a low frequency of modest side-effects. No clinical differences were found between the opioids.

Analgesia, Epidural↗
PubMed2004

Ropivacaine 0.1% with fentanyl 2 microg mL(-1) by epidural infusion for labour analgesia.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of 0.1% ropivacaine with fentanyl 2 microg mL(-1) via epidural for analgesia in labour. METHODS: In a randomized study, 80 nulliparous parturients in labour had epidural analgesia initiated with 0.2% ropivacaine and fentanyl and were then randomized to receive either 0.1% ropivacaine with fentanyl 2 microg mL(-1) at 10mL h(-1) (Group R1, n = 38) or 0.2% ropivacaine with fentanyl 2 microg mL(-1) at 8 ml h(-1) (Group R2, n = 39) as epidural infusions. Supplementary analgesia was provided on request with ropivacaine 0.2% 5 mL as an epidural bolus. RESULTS: There were no significant differences between the visual analogue pain scores either with respect to motor block or sensory block. The amount of local anaesthetic used was lower in the 0.1% ropivacaine group than in the 0.2% ropivacaine group (P = 0.001). Side-effects, patient satisfaction, labour outcome and neonatal outcomes were similar in both groups. CONCLUSIONS: An epidural infusion of 0.1% ropivacaine with fentanyl 2 microg mL(-1) at 10 mL h(-1) provided adequate analgesia in the first stage of labour. The level of analgesia was similar to that obtained using 0.2% ropivacaine with fentanyl 2 microg mL(-1) and with no differences with regard to motor or sensory block.

Adult↗
PubMed2004

Performance of bispectral index and auditory evoked potential monitors in detecting loss of consciousness during anaesthetic induction with propofol with and without fentanyl.

BACKGROUND AND OBJECTIVE: To investigate and compare the performance of bispectral index (BIS) and auditory evoked response index (AAI) in detecting the transition from consciousness to unconsciousness during anaesthesia induction by propofol, alone and in combination with fentanyl. METHODS: Anaesthesia was induced with either an intravenous infusion of 30 mg kg(-1)h(-1) of propofol plus 2 microg kg(-1) of fentanyl (Group PF, n = 20) or an intravenous infusion of 30 mg kg(-1) h(-1) of propofol plus normal saline (Group P, n = 20). BIS, AAI and the doses of propofol administered were recorded at the end-point of unresponsiveness to verbal commands. The propofol plasma concentration was also measured. RESULTS: The propofol dose and plasma propofol concentration required to achieve loss of consciousness were significantly lower in patients pretreated with fentanyl (P < 0.001). The mean BIS value at loss of consciousness was significantly different between the two groups (74.10 in Group PF vs. 60.80 in Group P) (P < 0.001). However, no difference in the AAI was seen between the two groups at loss of consciousness (32.90 in Group PF vs. 31.80 in Group P) (P > 0.05). In both groups, the regression analysis values (r-values) between BIS and plasma propofol concentrations at the onset of unconsciousness were higher than those between AAI and propofol concentrations (0.553 vs. 0.180 in Group P; 0.432 vs. 0.308 in Group PF). CONCLUSIONS: These results show that a fentanyl bolus is effective in augmenting the hypnotic effect of propofol during anaesthesia induction. AAI appears to be able to measure the transition from consciousness to unconsciousness at similar values, regardless of whether or not fentanyl pretreatment is used whereas the BIS values were not independent of fentanyl pretreatment. This suggests that AAI may be a better indicator of conscious status during propofol/fentanyl anaesthesia, where it appears to be independent of the anaesthesia regimen.

Adolescent↗
PubMed2004

Effects of remifentanil and fentanyl on intraocular pressure during the maintenance and recovery of anaesthesia in patients undergoing non-ophthalmic surgery.

BACKGROUND AND OBJECTIVE: To compare the effects of remifentanil and fentanyl on intraocular pressure during the maintenance and recovery of anaesthesia in patients undergoing elective non-ophthalmic surgery. METHODS: Thirty-two patients (ASA I-II) were randomized into two groups to receive either a continuous infusion of remifentanil (0.25-0.5 microg kg(-1) min(-1), n =16, Group R) or an intermittent bolus of fentanyl (2-5 microg kg(-1), n = 16, Group F) during the maintenance of anaesthesia. For the induction of anaesthesia, Group R received remifentanil 1 microg kg(-1) and Group F received fentanyl 2 microg kg(-1); both groups then received propofol 2 mg kg(-1) with vecuronium 0.1 mg kg(-1). Anaesthesia in both groups was maintained with a continuous infusion of propofol 4-8 mg kg(-1) h(-1). Ventilation of the lungs was controlled to a constant end-tidal PCO2 of 4.7-5.4 kPa. Blood pressure, electrocardiography, heart rate and oxygen saturation were monitored throughout anaesthesia. Intraocular pressure was determined before surgery, during the maintenance of anaesthesia, 2 min after emergence and in the recovery room using a Perkins hand-held applanation tonometer by an ophthalmologist blinded to the anaesthetic technique. RESULTS: After induction of anaesthesia, a significant decrease in intraocular pressure in the remifentanil group from 13.6 +/- 2.6 to 7.1 +/- 3.1 mmHg (P < 0.001) and in the fentanyl group from 13.7 +/- 2.2 to 9.7 +/- 3.4 mmHg (P < 0.001) was observed and maintained during anaesthesia. Thirty minutes after the end of anaesthesia, intraocular pressure returned to baseline values in both groups (remifentanil: 13.9 +/- 2.8 mmHg, P = 0.28; fentanyl: 13.6 +/- 2.3 mmHg, P = 0.59). The intraocular pressure and haemodynamic variables did not differ significantly between the two groups (intraocular pressure, P = 0.7327; blood pressure, P = 0.1295; heart rate, P = 0.8601). CONCLUSIONS: Remifentanil maintains intraocular pressure at an equally reduced level compared with fentanyl.

Adolescent↗
PubMed2005

Target-controlled infusion of remifentanil or fentanyl during extra-corporeal shock-wave lithotripsy.

BACKGROUND AND OBJECTIVE: Target-controlled infusions (TCIs) of remifentanil and fentanyl in conscious sedation regimes for extra-corporeal shock-wave lithotripsy have not been reported. We estimated the effect site concentrations of remifentanil and fentanyl needed to obtain adequate analgesia in 50% of patients (EC50) and compared both drugs in terms of intra- and post-procedure complications. METHODS: Forty-four adult patients were randomly distributed into two groups: Group R received remifentanil and Group F received fentanyl TCI with initial effect site concentrations of 1.5 and 2 ng mL(-1), respectively. Pain was assessed using a 10-point verbal analogue scale and <3 was considered adequate analgesia. Increments or decrements of 0.5 ng mL(-1) were then introduced for subsequent patients according to Dixon's up and down method. During the rest of the procedure, TCI was adjusted to maintain verbal analogue scale <3. RESULTS: Remifentanil and fentanyl EC50 were 2.8 ng mL(-1) (95% confidence interval (CI): 1.8-3.7 ng mL(-1)) and 2.9 ng mL(-1) (95% CI: 1.7-4.1 ng mL(-1)), respectively (n.s.). At EC50, the probability of having a respiratory rate <10 was 4% (95% CI: 0-57%) for remifentanil and 56% (95% CI: 13-92%) for fentanyl. Hypoxaemia, vomiting and sedation were more frequent in Group F during and after the procedure (P < 0.05). CONCLUSIONS: A similar EC50 but more respiratory depression, sedation and PONV were found with fentanyl TCI than with remifentanil TCI.

Adolescent↗
PubMed2005

Effects of hyperbaric spinal ropivacaine for caesarean section: with or without fentanyl.

BACKGROUND AND OBJECTIVE: Adding various opioids to the local anaesthetic solution administrated intrathecally improves the analgesic potency of spinal analgesia. The purpose of this study was to evaluate the efficacy and safety of intrathecal fentanyl 10 microg added to 15 mg hyperbaric ropivacaine in patients undergoing caesarean section under spinal anaesthesia. METHODS: Thirty-seven healthy, full-term parturients were randomly assigned into two groups: Group S (saline group, n=17) received 15 mg hyperbaric ropivacaine in 2.5 mL + 0.5 mL saline; Group F (fentanyl group, n=20) received 15 mg hyperbaric ropivacaine in 2.5 mL + 10 microg fentanyl in 0.5 mL, intrathecally. Characteristics of spinal block, intraoperative quality of spinal anaesthesia, time to first feeling of pain (complete analgesia), time to first request of analgesics postoperatively (effective analgesia), side-effects and fetal outcomes were evaluated. RESULTS: Regression of sensory block to L5 was significantly prolonged in the fentanyl group compared with the saline group (P = 0.001). Time to the first feeling of pain (130.6 +/- 15.8 min vs. 154.3 +/- 31.1 min; P = 0.008) and the first analgesic requirement (161.2 +/- 32.6 min vs. 213.0 +/- 29.3 min; P < 0.001) were significantly shorter in the saline group compared with the fentanyl group. Side-effects, umbilical arterial and venous blood gases did not differ between the groups. Apgar scores were similar in both groups and no infants had an Apgar score < or =7 at 5 min. CONCLUSIONS: The addition of fentanyl 10 microg, to hyperbaric ropivacaine 15 mg, for spinal anaesthesia increased the duration of analgesia in the early postoperative period in patients undergoing caesarean delivery.

Adjuvants, Anesthesia↗