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PubMed2003

Hypobaric bupivacaine spinal anesthesia for cystoscopic intervention: the impact of adding fentanyl.

BACKGROUND AND OBJECTIVE: Addition of fentanyl to hyperbaric bupivacaine spinal anesthesia prolonged the duration of sensory block. This study seeks to test the hypothesis that adding fentanyl to small dose hypobaric spinal anesthesia will improve intraoperative patients and surgeon satisfaction without delay in recovery. METHODS: Patients (n = 80) subjected to minor cystoscopic surgery were randomly assigned to have spinal anesthesia with either 5 mg bupivacaine 0.1% or 5 mg bupivacaine 0.1% mixed with 20 micrograms fentanyl. The main outcome measures included intraoperative patient and endoscopist satisfaction, sedative/analgesic supplementation, postoperative side effects and time to ambulation. RESULTS: Patients in the bupivacaine group needed more analgesic supplementation. Analgesia was more adequate in the bupivacaine-fentanyl group. Pruritus was the main side effect in the bupivacaine fentanyl group. Ambulation and discharge of patients were nearly the same in both groups. CONCLUSIONS: Spinal anesthesia with small dose (5 mg) hypobaric (0.1%) bupivacaine mixed with fentanyl (20 micrograms) produced adequate anesthesia for short cystoscopic procedures with minimal side effects and without delay in ambulation.

Adult↗
PubMed2005

[Transdermal fentanyl for the management of cancer pain: a survey of 4492 patients].

OBJECTIVE: To evaluate the efficacy and adverse effects of transdermal fentanyl in management of patients with cancer pain. METHODS: A total of 4492 patients (aged 3-90) with cancer pain were enrolled in this multicenter study. The mean age was 58.5 (3 approximately 90) years old. All patients received transdermal fentanyl. The patients were asked to record the attacks of pain, quality of life, and any side effects of the treatment. RESULTS: Baseline mean pain intensity was 7.37. On days 1, 3, 6, 9, 15, and 30, the mean scores of pain were decreased to 4.04, 2.98, 2.52, 2.19, 1.85 and 1.61, respectively (P < 0.01). The effective rate was 96.8%. The mean doses of fentanyl were 32.37 microg/h (25-200 microg/h) on the initial day, 42.57 microg/h and 49.57 microg/h (25-225 microg/h) on days 15 and 30. The quality of life was significantly improved after treatment (P < 0.01). The common side effects were constipation (9.8%), nausea (13.6%), dizziness (6.5%), vomiting (3.9%), sedation (2.0%) and respiratory depression (0.2%). The incidence of constipation was related to age, and the incidence of vomiting and difficulty of urination was related to gender. The majority (84.5%) of patients preferred continuation of the treatment with transdermal fentanyl. CONCLUSION: Transdermal fentanyl for the patients with cancer pain is effective, safe, convenient and can improve the quality of life. Transdermal fentanyl can be recommended as one of first-line drugs for the treatment of patients with moderate to severe cancer pain.

Administration, Cutaneous↗
PubMed2005

Fentanyl plasma levels after modified ultrafiltration in infant heart surgery.

Modified ultrafiltration (MUF) is a novel application of ultrafiltration to remove excess water after cardiopulmonary bypass in pediatric patients that was first reported in 1991. It has gained widespread use as an important adjunct to fluid management in neonates, infants, and pediatric cardiac surgery patients. Now more than two decades after its original description, the exact mechanism of action and effects of this therapy are still a matter of discussion. The aim of this study was to determine the effects of MUF on plasma fentanyl levels using a two-phase in vitro and in vivo study. We designed an in vitro experimental model to simulate MUF that allowed measurement of plasma fentanyl levels while eliminating biologic variables. Plasma fentanyl levels were measured during five consecutive operations on neonates and infants undergoing repair of congenital heart defects. Increases in plasma fentanyl levels were found in vitro as well as in vivo. Fentanyl plasma levels more than doubled after MUF (increased by a factor of 2.22, from 12.4 to 27.5 ng/ml in vivo). The increase in plasma fentanyl levels needs to be taken into account when delivering anesthetic care and when analyzing the effect of MUF on outcome variables.

Cardiopulmonary Bypass↗
PubMed1991

Evaluation of esmolol and fentanyl in controlling increases in heart rate and blood pressure during endotracheal intubation.

Laryngoscopy and intubation cause an adrenergic response manifested by tachycardia and hypertension. Various pharmacological agents, including fentanyl, have been administered prior to induction in an attempt to attenuate the adrenergic response but they all have limitations. Esmolol, an ultrashort-acting cardioselective beta blocker, has been administered by infusion to successfully protect surgical patients from the stresses of intubation. The objective of our study was to determine if esmolol would be equally effective when administered in a bolus with and without fentanyl. Forty-four ASA I and II females undergoing elective surgery were randomly divided into four groups and received the following agents prior to intubation: Group 1-esmolol 1 mg/kg and fentanyl 2 micrograms/kg, Group 2-placebo (normal saline), Group 3-esmolol 1 mg/kg and Group 4-fentanyl 3.5 micrograms/kg. Groups 1 and 4, which received fentanyl, demonstrated significantly less elevation in blood pressure. Esmolol appeared to attenuate increases in heart rate. Esmolol has a tissue distribution time of 2 minutes and an elimination half-life of 9 minutes. The window of its availability to the tissues is narrow, and timing of bolus administration is more critical than in administration by infusion. Doses in excess of 1 mg/kg appear to be necessary for effective control of heart rate. However, when used with fentanyl, esmolol provides effective protection against the adrenergic response to laryngoscopy and intubation.

Adrenergic beta-Antagonists↗
PubMed2006

Comparison of remifentanil or fentanyl administration during isoflurane anesthesia for coronary artery bypass surgery.

BACKGROUND: The combination of inhalational agents with moderate doses of fentanyl is popular in cardiac anesthesia. Remifentanil is a new opioid metabolized by non-specific esterases. The aim of our study was to assess whether remifentanil may be superior to fentanyl during isoflurane anesthesia for coronary artery surgery. MATERIAL/METHODS: Forty patients aged 40-70 years with stable coronary artery disease were randomly allocated to two groups: remifentanil was used in 20 patients (group I) and fentanyl was used in 20 patients (group II). Induction of anesthesia was performed with remifentanil infusion (0.5 microg/kg/min) or a bolus dose of fentanyl (5 microg/kg) followed by a bolus of etomidate and pancuronium. Maintenance of anesthesia was provided by isoflurane and infusion of the study opioid, with the rate adjusted according to systolic blood pressure values. Hemodynamic parameters were registered before and after the induction of anesthesia, skin incision, sternotomy, aortic cannulation, termination of cardiopulmonary bypass, chest closure, and skin closure. RESULTS: Heart rate and mean arterial pressure values were significantly lower in the remifentanil group, while systemic vascular resistance was higher in the fentanyl group in the measurements taken before the initiation of cardiopulmonary bypass. No differences were found between groups in the values of mean pulmonary pressure, pulmonary artery wedge pressure and transpulmonary pressure gradient, central venous pressure, and cardiac index. CONCLUSIONS: Remifentanil is safe during inhalation anesthesia for coronary artery surgery and it appears to be more effective than fentanyl in blunting hemodynamic response before the initiation of cardiopulmonary bypass surgery.

Adult↗
PubMed2006

[Security evaluation of bupivacaine, ropivacaine combined with fentanyl in postoperative continuous epidural analgesia].

OBJECTIVE: To investigate the effects, side-effects and security of bupivacaine, ropivacaine combined with fentanyl in postoperative continuous epidural analgesia. METHODS: A total of 1 600 postoperative continuous epidural analgesia patients receiving different agents in SICU were divided into two groups: 0.1% bupivacaine +5 microg/ml fentanyl group (group B, n = 920) and 0.2% ropivacaine +2 microg/ml fentanyl group (group R, n = 680). The effects (visual analog-scale score and content to analgesia), side effects were analyzed retrospectively in the two groups. RESULTS: Compared with group B, patients in group R had higher analgesia contentment (P < 0.05), but no difference in visual analog-scale score was found in the two groups. The incidences of urinary retention, nausea and vomiting, skin itching in group B were significantly higher than those in group R (P < 0.05). In each group, patients over sixty had higher ratio of hypotension than those under sixty (P < 0.05); The female patients had a higher incidence of nausea and vomiting than male patients (P < 0.05); The incidence of debility and numbness of lower limbs in patients with lumbar segments epidural analgesia was higher than those with thoracic analgesia (P < 0.05). CONCLUSIONS: 0.1% bupivacaine +5 microg/ml fentanyl and 0.2% ropivacaine +2 microg/ml fentanyl can provide adequate pain relief in postoperative continuous epidural analgesia, and 0.2% ropivacaine +2 microg/ml fentanyl comes with less side effects. The incidence of complication is related with analgesics, age, gender and the position of epidural puncture.

Adolescent↗
PubMed1991

Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures.

To evaluate the efficacy of opiate administration regimens, 32 patients with multiple rib fractures were prospectively randomized to receive either continuous epidural (ED) or continuous intravenous (IV) infusions of fentanyl. Dosage was titrated to individual subjective pain relief. Ventilatory function tests (VFTs), arterial blood gases (ABGs), and visual analog scores were obtained before and after the institution of analgesia. Post-analgesia values were compared with pre-analgesia values using a two-tailed paired t-test looking for significant changes produced by the analgesic method. Both methods significantly improved analog pain scores. The ED method produced improvement in both maximum inspiratory pressure (MIP) and vital capacity (VC), whereas IV analgesia only produced improvement in VC. Intravenous fentanyl produced increases in PaCO2 and decreases in PaO2, whereas no significant changes in ABGs were observed with ED fentanyl administration. Side effects were similar between the groups, with pruritus being more pronounced with ED fentanyl administration. The data demonstrate that the continuous ED fentanyl method offers excellent relief of pain and improvement in ventilatory function and has distinct advantages over IV fentanyl administration with respect to changes in ABGs and MIP. The continuous infusion of epidural opiates should be the preferred analgesic method for patients at high risk of developing pulmonary complications following multiple rib fractures.

Adult↗
PubMed1990

The evaluation of subarachnoid administration of fentanyl for surgery and postoperative analgesia in patients undergoing cesarean section.

The use of spinal opioids for postoperative analgesia has gained popularity in recent years. In this study, subarachnoid fentanyl 20 micrograms was evaluated to determine its efficacy for postoperative analgesia, its possible side effects and its effects on the newborn. Sixty ASA class I or II at-term parturients undergoing elective cesarean section were randomly divided into two groups. In one group fentanyl 20 micrograms (0.4 ml) with 0.5% heavy marcaine 2.0 ml was given intrathecally and in the other group only 0.5% heavy marcaine 2.0 ml with CSF 0.4 ml was given intrathecally. The average time for patients in the fentanyl group to demand the first dose of narcotic for pain was 6.8 +/- 3.2 h and in the control group it was 3.9 +/- 1.1 h. The incidences of postoperative nausea and vomiting were higher in the fentanyl group than in the control group. Pruritus was only found in the fentanyl group and amounted to 50%. Early or late respiratory depression was not found in the fentanyl group. During operation, all patients were wakeful and alert. Neonatal condition as determined by 1-min and 5-min Apgar score was satisfactory and showed no significant difference in both groups. Examination on neurobehavior and reflexes done at the baby room showed no abnormality in both groups.

Adult↗
PubMed1990

Stability of fentanyl citrate in 0.9% sodium chloride solution in portable infusion pumps.

The stability of fentanyl citrate diluted with 0.9% sodium chloride injection for use in portable infusion pumps was studied. The commercially available injection containing 50 micrograms of fentanyl per milliliter was diluted to a concentration of 20 micrograms/mL. Twelve 100-mL portions of the dilute solution were placed in polyvinyl chloride infusion pump drug reservoirs; six were stored at 3 degrees C and six at 23 degrees C; three at each temperature were overwrapped with polypropylene-Mylar. Initially and after 5, 10, 20, and 30 days of storage, 1-mL samples were taken from each reservoir, inspected for color change and precipitation, and assayed for fentanyl concentration by high-performance liquid chromatography. Initially and on day 30, pH of the samples was checked. No precipitation or change in color or pH was observed. No substantial decrease in fentanyl concentration was found in either the wrapped or unwrapped samples at either temperature, although concentrations on day 30 in the samples at 23 degrees C were slightly lower than those at 3 degrees C. Under the conditions studied, fentanyl citrate solutions containing 20 micrograms of fentanyl per milliliter can be stored for 30 days in polyvinyl chloride reservoirs for portable infusion pumps.

Chromatography, High Pressure Liquid↗
PubMed1987

Effects of fentanyl on vasopressin secretion in human subjects.

To test the influence of an opioid on vasopressin (AVP) secretion, plasma AVP concentration was measured in five semirecumbent unmedicated volunteers before and during two continuous i.v. infusions of fentanyl. Infusion rates were adjusted to produce steady-state plasma fentanyl concentrations of 2.0 +/- 0.4 and 4.1 +/- 0.6 ng/ml; mild to moderate hypercarbia was induced during the control and infusion periods. Fentanyl increased plasma AVP concentration in a dose-dependent manner to 559 +/- 215 and 929 +/- 199% of the basal level of 1.9 +/- 0.7 pg/ml. Neither mild hypercarbia (PCO2 = 50 +/- 1 mm Hg) in the absence of fentanyl nor moderate hypercarbia (PCO2 = 66 +/- 3 mm Hg) in the presence of fentanyl changed plasma AVP concentration. Neither fentanyl nor hypercarbia, nor the combination of the two, altered plasma renin activity.

Adult↗
PubMed1987

Protection by fentanyl against cardiac dysrhythmias during induction of anaesthesia.

The effect of fentanyl on electrocardiographic changes during anaesthetic induction was studied in 113 adults and 77 children. The adults were pretreated with fentanyl 1, 2 or 3 micrograms kg-1 and the children received fentanyl 1 or 2 micrograms kg-1 as pretreatment. The control groups received no pretreatment. Two minutes after the pretreatment, thiopentone 5 mg kg-1 was injected followed by succinylcholine 1.5 mg kg-1 before laryngoscopy and intubation. In control adults, ventricular ectopic beats (VEB) occurred in 26% of the patients whereas fentanyl in all doses totally prevented them. In children, the incidence of VEB was 22% in the control group whereas both doses of fentanyl prevented the occurrence of VEB. In any doses, fentanyl did not prevent the prolongation of QT interval after succinylcholine.

Adult↗
PubMed1986

Pharmacokinetics of fentanyl in neonates.

The pharmacokinetics of fentanyl were studied in fourteen neonates undergoing major surgical procedures. Five patients were less than 1 day of age, seven were 1-4 days old, and two were 7-14 days old. Fentanyl was given intravenously, 10 micrograms/kg (n = 1), 25 micrograms/kg (n = 4), or 50 micrograms/kg (n = 9), and plasma concentrations measured at intervals of up to 18 hr. Average weight was 2.9 kg. The injection of 25 or 50 micrograms/kg of fentanyl over 1-3 min was hemodynamically well-tolerated by all patients. Four newborns without respiratory impairment secondary to surgery or disease needed ventilatory support for an average of 24 hr (range 11-40 hr). Plasma concentrations of fentanyl were most appropriately described by a two-compartment model. The mean +/- SEM values of selected model parameters were volume of the central compartment, 1.45 +/- 0.34 L/kg; volume of distribution at steady state, 5.1 +/- 1 L/kg; clearance, 17.94 +/- 4.38 ml X kg-1 X min-1; and terminal elimination half-life (t 1/2 beta), 317 +/- 70 min. In seven patients transient rebound in plasma fentanyl concentrations of 0.5 ng/ml or greater occurred. In three patients with markedly increased intraabdominal pressure, the t 1/2 beta was 1.5-3 times the population mean. Thus fentanyl disposition in neonates is highly variable, but the t 1/2 beta is predictably prolonged in the presence of increased abdominal pressure.

Age Factors↗
PubMed1980

[Plasma concentration of fentanyl administered at a constant flow rate during prolonged anesthesia].

By radio-immunological estimation using fentanyl H-3, a study was undertaken in ten adults under anaesthesia of long duration obtained by infusion at a constant rate of alfadione and fentanyl of the plasma concentration of fentanyl during and after anaesthesia. Anaesthesia was induced by the administration of 4.3 ml of alfadione and 0.084 mg of fentanyl. The maintenance dose was on average 0.15 ml/kg-/h-1 +/- 0.03 of alfadione and 2.96 micrograms/kg-1/h-1 +/- 0.58 of fentanyl. The mean duration of anaesthesics was 388 minutes +/- 104. The results of this study showed that from the third hour onwards a plateau of serum concentration was established around a mean value of the order of 4.8 micrograms/l-1. The study of excretion curves demonstrated the existence of a three compartment system with respective half lives of 12.75 and 510 minutes. Maintenance of a stable plasma concentration may be explained by an increase in tissue diffusion (increase in mid and long term half life in comparison with single injections) and by increased metabolism. This study provided pharmacokinetic evidence to justify the administration of fentanyl at a constant flow rate preceded by a loading dose.

Adult↗
PubMed1984

EEGs during high-dose fentanyl-, sufentanil-, or morphine-oxygen anesthesia.

In 49 patients undergoing open-heart surgery we compared the electroencephalographic (EEG) effects of high-dose morphine, fentanyl, or sufentanil with O2, using two computerized analysis and display techniques: a period analysis (the Klein method) and an aperiodic analysis (the Neurometrics monitor). During fentanyl or sufentanil anesthesia, both techniques revealed a general decrease in frequency, shown by the aperiodic analysis primarily as a marked increase in the very low frequency range: an increase in the 1-Hz bin (TP1, in muv2) from 2.80 X 10(4) +/- 3.20 X 10(4) (SD) to 45.1 X 10(4) +/- 27.2 X 10(4) for fentanyl and from 3.11 X 10(4) +/- 2.83 X 10(4) to 52.8 X 10(4) for sufentanil. The cumulative percent power at 3 Hz (CP3) increased from 27.2 +/- 6.8 to 83.0 +/- 11.0 for fentanyl and from 22.7 +/- 5.2 to 85.1 +/- 10.4 for sufentanil, while the frequency at 90% cumulative percent power (F90, in Hz) decreased from 17.8 +/- 2.9 to 7.9 +/- 2.8 for fentanyl and 16.4 +/- 5.2 to 5.6 +/- 4.3 for sufentanil. The changes with morphine were less obvious, with some attenuation of high-frequency power shown by the Klein method, and an increase from 24.1 +/- 8.6 to 59.3 +/- 20.7 with CP3, but no change in TP1. Low-frequency power with the period analysis and TP1 with the aperiodic analysis decreased between laryngoscopy and the incisions with fentanyl and sufentanil.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Factors regulating drug cue sensitivity: the effect of frustrative non-reward in fentanyl-saline discrimination.

In this study, rats were trained to discriminate 0.04 mg/kg of fentanyl from saline in two-lever food-reinforced procedure. The study examined the effects of a manipulation of reinforcement (i.e. frustrative non-reward; FNR) on several characteristics of fentanyl-saline discrimination. It was found that asymmetrical FNR in either saline or drug sessions retarded the acquisition of the discrimination and codetermined response bias; symmetrical FNR in both types of sessions had no effect. Asymmetrical FNR in saline sessions steepened the slope of the generalization of fentanyl, but also of morphine and sufentanil; asymmetrical FNR in drug sessions flattened the gradient's slope. Symmetrical FNR had effects on slope which were similar to those of asymmetrical FNR in saline sessions. Both symmetrical and asymmetrical FNR also appeared to affect the ED50-value of different agonists, and the ED50-value of naloxone in antagonizing 0.04 mg/kg of fentanyl. It thus appears that reinforcement plays a major role in the acquisition of fentanyl-saline discrimination and in the quantitative characteristics of the stimulus generalization gradient of fentanyl and other agonists. It is also suggested that the training drug itself may interact with the effects of FNR on its own gradient.

Animals↗
PubMed1983

Fentanyl-O2-N2O rigidity and pulmonary compliance.

Induction of anesthesia with fentanyl has been associated with such extreme rigidity as to cause failure of bag-and-mask ventilation. The etiology of this failure has not been investigated. Therefore, fentanyl-induced rigidity was studied in 5 control patients to establish the dose at which ventilation became impossible and in 5 patients with tracheostomies to investigate changes in pulmonary compliance. Anesthesia was induced with 3 micrograms/kg/min fentanyl to a total of 30 micrograms/kg. In control patients, failure to maintain bag-and-mask ventilation occurred at a mean fentanyl dose of 17 micrograms/kg. In patients with tracheostomies, compliance decreased 16% below baseline levels with fentanyl-100% O2 and an additional 22% with 60% N2O, returning to baseline levels after paralysis. It is concluded that the site of the cause of inability to maintain bag-and-mask ventilation after fentanyl lies above the trachea, specifically at the glottis. Glottic rigidity causes glottic closure and upper airway obstruction.

Adult↗
PubMed1982

Effects of fentanyl, and the antagonism by naloxone, on regional blood flow and biochemical variables in conscious rabbits.

Effects of fentanyl (cumulative doses: 25, 75 and 125 micrograms.kg-1, i.v.) on respiratory, systemic and regional haemodynamic and biochemical variables were studied in the conscious rabbit. The initial dose of fentanyl (25 micrograms.kg-1) produced a rise in blood pressure and a decrease in heart rate but, on subsequent doses, smaller effects were observed. The drug produced changes in arterial blood gases which were due to a severe decrease in respiratory frequency and an increase in muscular rigidity of chest and neck muscles. The blood flow to skin, stomach, mesentery plus pancreas, bones and fat was decreased by fentanyl. These changes resemble those obtained during alpha-adrenergic stimulation and, thus, may be related to a release of catecholamines during respiratory depression. On the contrary, however, hepatic arterial blood flow was increased and this effect may be responsible for the rapid metabolism and a short duration of action of fentanyl. Fentanyl also caused an increase in the concentration of glucose, lactate and inorganic phosphates in the arterial blood. These changes are probably due to hypoxia. Administration of naloxone not only reversed the residual effects of previous fentanyl administration but also antagonized the respiratory, haemodynamic and biochemical responses to the morphinomimetic drug.

Animals↗
PubMed1982

Low-dose fentanyl blunts circulatory responses to tracheal intubation.

The effect of fentanyl, 8 micrograms/kg, used as an adjunct to thiopental for induction of anesthesia, on the circulatory response to tracheal intubation was investigated in 36 patients undergoing major vascular surgery. Patients were randomly assigned to receive either thiopental, 6 mg/kg, alone (N = 18), or thiopental, 3 mg/kg, along with fentanyl, 8 micrograms/kg (N = 18), for induction of anesthesia. The electrocardiogram, arterial pressure, pulmonary capillary wedge pressure, cardiac output, and central venous pressure were measured during induction of anesthesia, laryngoscopy, and intubation. Mean arterial blood pressure increased more following intubation in patients given thiopental than in patients given fentanyl-thiopental, reaching a peak value of 144 +/- 4 torr in patients receiving thiopental only, compared with 108 +/- 6 torr in those receiving fentanyl and thiopental (p less than 0.0001). Increases in systolic blood pressure, diastolic blood pressure, and pulmonary capillary wedge pressure with intubation were also significantly greater following administration of thiopental than following fentanyl-thiopental. Doses of fentanyl that are low enough to cause little postoperative respiratory depression significantly blunt postintubation hypertension when used as an adjunct to thiopental.

Anesthesia↗