Association of lipophilic opioids and hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Randomized controlled study

PURPOSE:To evaluate the efficacy and side-effects of fentanyl and sufentanil combined with hyperbaric spinal bupivacaine in elective cesarean section.METHODS:A prospective, randomized, double-blind study with 64 term parturients, distributed into 2 groups according to the opioid combined with hyperbaric bupivacaine 0.5% (10mg): GF - fentanyl (25µg) and GS - sufentanil (5.0µg). The latency and maximum sensory block level; degree and duration of motor block; duration and quality of analgesia; maternal-fetal repercussions were evaluated. This was an intention-to-treat analysis with a 5% significance level.RESULTS:The latency period, maximum sensory block level, motor block degree and perioperative analgesia were similar in both groups. Motor block and analgesia had a longer duration in the sufentanil group. Maternal adverse effects and neonatal repercussions were similar. The incidence of hypotension was higher in the fentanyl group. In both groups, there was a predominance of patients who were awake and either calm or sleepy.CONCLUSIONS:The addition of fentanyl and sufentanil to hyperbaric subarachnoid bupivacaine was shown to be effective for the performance of cesarean section, and safe for the mother and fetus. Analgesia was more prolonged with sufentanil.(AU)

Comparing the pain of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy

PURPOSE: To evaluate the pain on injection of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy. METHODS: Total 439 patients were randomly allocated into 6 groups. Propofol & fentanil (PF) group received 1 μg/kg fentanyl, propofol & sufentanil (PS) group received 0.1 μg/kg sufentanil and propofol & remifentanyl (PR) group received 1 μg/kg remifentanyl prior to administration of 1-2 mg/kg of propofol. The propofol & half-fentanil (Pf) group, propofol & half-sufentanil (Ps) group and propofol & half-remifentanyl (Pr) group were given 0.5 μg/kg fentanyl, 0.05 μg/kg sufentanil and 0.5 μg/kg remifentanyl, respectively and later administrated 1-2 mg/kg propofol. All patients were monitored for the blood pressure (MAP), heart rate (HR), and oxygen saturation (SpO2). Additionally, the pain intensity was assessed using a 4-point verbal rating scale (VRS) by professional doctors. RESULTS: The incidence of pain due to propofol injection in Ps group (33.8%) was significantly lower than other 5 groups. The heart rate (HR) and mean arterial pressure (MAP) were maintained within the normal limits in all six groups and there was no hypotension or bradycardia encountered during the study period. CONCLUSION: Propofol and sufentanil group was the most suitable program for painless gastroscopy. .(AU)

Analgesia epidural com clonidina ou sufentanil epidural em cadelas submetidas à ovariosalpingohisterectomia sob anestesia geral inalatória / Epidural analgesia with clonidine or sufentanil in dogs submitted to ovariohysterectomy under general anesthesia

Background: Epidural administration of opioids and a2-adrenergic agonists allows the use of smaller doses when administered by other routes, providing analgesia during trans and post-anesthetic periods, reducing side effects and postoperative stress. Sufentanil in higher doses caused minimal hemodynamic changes in dogs. When given epidurally, clonidine produces analgesia without motor block by a non-opioid mechanism of action. The aim of this study was to evaluate the quality and duration of analgesia as well the cardiorespiratory changes resulting from administration of epidural clonidine or sufentanil in dogs anesthetized with halothane. Materials, Methods & Results: Twenty adult health dogs were used divided into two groups, clonidine (CLO) group and sufentanil (SUF) receiving 150 µg and 50 µg respectively epidural. After induction with thiopental and propofol in a mixture of equal parts (0.8 mg/kg), general anesthesia was maintained with halothane in a Bain circuit for further epidural administration of drugs. Heart rate and cardiac rhythm, respiratory rate, tidal volume, min volume, systolic arterial pressure, body temperature, oxygen saturation of oxyhemoglobin, halothane vaporization were evaluated at times T0 (baseline) and every 15 min until the end of the procedure (T1, T2, T3, T4). The arterial blood gas analysis was performed at T0G (baseline) and 30 min and 2 h after epidural (T1G, T2G) evaluating pH, PaO2 , PaCO2 , BE, HCO3 - and TCO2 . Postoperative analgesia was assessed by the scale of Firth & Haldane (1999) every hour for five hours, starting one hour after the surgery. All parametric variables were analyzed by use of a 1-way ANOVA for repeated measures, followed by a Dunnet test to compare all sample collection times with baseline data (0 min). For comparisons among groups, for each time, test t was used. Differences were considered significant when P < 0.05. The results showed a significant reduction in heart rate after 15 min lasting for 60 min with a reduction in SAP, but no signs of hypotension. A reduction in respiratory rate was also observed in the SUF group and vaporization of halothane in both groups with increase in SpO2 . There was no difference in cardiac rhythm and tidal volume, there was only an increase in minute volume at 60 min in the SUF group. Body temperature also decreases at all times. Discussion: The reduction in heart rate was observed since sufentanil have discrete sympatholytic and vagotonic activity and a2-adrenergic agonists may also cause bradycardia by vagomimetic effect. The drugs used can also cause a reduction in blood pressure, but hypotension was not observed in this study, corroborating with several authors. The lipophilic opioids suffer greater absorption by the blood vessels in the epidural region resulting in peak plasma concentration and early respiratory depression, while the a2-adrenergic agonists cause respiratory depression secondary to central nervous system depression. The observed reduction in vaporization is due to potentiation of drugs used. Analgesia in the intraoperative period can be proved since tachycardia, tachypnea, or hypertension during clamping of the ovarian pedicles was not observed and in the immediate postoperative period, both drugs proved effective with Firth & Haldane numerical scale. The doses employed by epidural reduced the need for halothane demonstrating intra-operative analgesic effect. Furthermore, sufentanil caused severe respiratory depression, however it is suggested greater efficacy when compared to clonidine in the immediate postoperative period.(AU)

Analgesia epidural com clonidina ou sufentanil epidural em cadelas submetidas à ovariosalpingohisterectomia sob anestesia geral inalatória / Epidural analgesia with clonidine or sufentanil in dogs submitted to ovariohysterectomy under general anesthesia

Background: Epidural administration of opioids and a2-adrenergic agonists allows the use of smaller doses when administered by other routes, providing analgesia during trans and post-anesthetic periods, reducing side effects and postoperative stress. Sufentanil in higher doses caused minimal hemodynamic changes in dogs. When given epidurally, clonidine produces analgesia without motor block by a non-opioid mechanism of action. The aim of this study was to evaluate the quality and duration of analgesia as well the cardiorespiratory changes resulting from administration of epidural clonidine or sufentanil in dogs anesthetized with halothane. Materials, Methods & Results: Twenty adult health dogs were used divided into two groups, clonidine (CLO) group and sufentanil (SUF) receiving 150 µg and 50 µg respectively epidural. After induction with thiopental and propofol in a mixture of equal parts (0.8 mg/kg), general anesthesia was maintained with halothane in a Bain circuit for further epidural administration of drugs. Heart rate and cardiac rhythm, respiratory rate, tidal volume, min volume, systolic arterial pressure, body temperature, oxygen saturation of oxyhemoglobin, halothane vaporization were evaluated at times T0 (baseline) and every 15 min until the end of the procedure (T1, T2, T3, T4). The arterial blood gas analysis was performed at T0G (baseline) and 30 min and 2 h after epidural (T1G, T2G) evaluating pH, PaO2 , PaCO2 , BE, HCO3 - and TCO2 . Postoperative analgesia was assessed by the scale of Firth & Haldane (1999) every hour for five hours, starting one hour after the surgery. All parametric variables were analyzed by use of a 1-way ANOVA for repeated measures, followed by a Dunnet test to compare all sample collection times with baseline data (0 min). For comparisons among groups, for each time, test t was used. Differences were considered significant when P < 0.05. The results showed a significant reduction in heart rate after 15 min lasting for 60 min with a reduction in SAP, but no signs of hypotension. A reduction in respiratory rate was also observed in the SUF group and vaporization of halothane in both groups with increase in SpO2 . There was no difference in cardiac rhythm and tidal volume, there was only an increase in minute volume at 60 min in the SUF group. Body temperature also decreases at all times. Discussion: The reduction in heart rate was observed since sufentanil have discrete sympatholytic and vagotonic activity and a2-adrenergic agonists may also cause bradycardia by vagomimetic effect. The drugs used can also cause a reduction in blood pressure, but hypotension was not observed in this study, corroborating with several authors. The lipophilic opioids suffer greater absorption by the blood vessels in the epidural region resulting in peak plasma concentration and early respiratory depression, while the a2-adrenergic agonists cause respiratory depression secondary to central nervous system depression. The observed reduction in vaporization is due to potentiation of drugs used. Analgesia in the intraoperative period can be proved since tachycardia, tachypnea, or hypertension during clamping of the ovarian pedicles was not observed and in the immediate postoperative period, both drugs proved effective with Firth & Haldane numerical scale. The doses employed by epidural reduced the need for halothane demonstrating intra-operative analgesic effect. Furthermore, sufentanil caused severe respiratory depression, however it is suggested greater efficacy when compared to clonidine in the immediate postoperative period.

Variabilidade da freqüência cardíaca em cães anestesiados com infusão contínua de propofol e sufentanil / Heart rate variability in dogs anesthetized with propofol and sufentanil

Foram avaliados os efeitos do propofol associado ao sufentanil sobre o balanço das atividades simpática e parassimpática do coração, investigando-se um possível efeito dose dependente do opióide. Analisou-se a variabilidade da freqüência cardíaca (VFC) de 12 cães adultos pré-medicados com maleato de acepromazina e anestesiados com propofol e três doses diferentes de sufentanil, que variou de 0,025 a 0,1µg/kg/min. Registrou-se o eletrocardiograma 15 minutos após a medicação pré-anestésica e 15, 30, 60, 90 e 120 minutos após a indução anestésica. A VFC foi calculada no domínio da freqüência, mediante análise de 10 intervalos RR consecutivos. Houve redução acentuada da freqüência cardíaca, mas a VFC permaneceu relativamente inalterada.(AU)

The effects of propofol and sufentanil on cardiac sympathetic and parasympathetic balance were studied, in order to evaluate if sufentanil plays a role in this balance. The heart rate variability of 12 adult dogs was assessed, after premedication with acepromazine and anesthetized with propofol and three different doses of sufentanil, ranging from 0.025 to 0.1µg/kg/min. Electrocardiograms were recorded 15 minutes after premedication and 15, 30, 60, 90, and 120 minutes after anesthetic induction. Heart rate variability was calculated in frequency domain through the analysis of 10 consecutive RR intervals. Results showed an absence of important changes in heart rate variability, although a significant decrease in heart rate was observed.(AU)

Emprego do sufentanil em cães pré-tratados com levomepromazina e anestesiados pela cetamina / Use of sufentanil in dogs premedicated with levomepromazine and anesthezed with ketamine

O objetivo deste estudo foi avaliar as possíveis alterações cardiorrespiratórias provenientes da administração de sufentanil, em cães pré-tratados com levomepromazina e anestesiados pela cetamina. Para tanto, foram utilizados 16 cães adultos, distribuídos em dois grupos, denominados de GS e GP. Aos animais do GS, foi administrada levomepromazina (1mg/kg, IV). Decorridos 15 minutos, administrou-se cetamina (15mg/kg, IM) e após 10 minutos, sufentanil (1µg/kg, IV). Nos animais do GP foi empregada a mesma metodologia, substituindo-se o sufentanil por solução fisiológica a 0,9% (placebo). As observações das variáveis tiveram início imediatamente antes da aplicação dos fármacos (M0), 15 minutos após a administração da levomepromazina (M15), 10 minutos após a administração da cetamina (m25) e 10 minutos após a administração do sufentanil, no GS ou placebo, no GP (M35). As demais medidas foram efetuadas a intervalos de 10 minutos após M35, durante 20 minutos (M45 e M55, respectivamente). Foram estudados os seguintes parâmetros: freqüência cardíaca (FC); pressões arteriais sistólicas (PAS), diastólica (PAD) e média (PAM); freqüência respiratória (f); saturação de oxi-hemoglobina (SpO₂); concentração de dióxido de carbono ao final da expiração (ETCIO₂) e temperatura retal (TR). A avaliação estatística das variáveis foi efetuada por meio de análise de perfil a 5% de probabilidade. A análise dos resultados permitiu concluir que o sufentanil altera a função cardiovascular, por diminuí-la; prejudica a ventilação e determina discreta influência sobre a temperatura retal(AU)

This study aimed at investigating the cardiorespiratory promoted by the infusion of sufentanil in dogs premedicated with levomepromazine, and anesthetized with ketamine. For such, sixteen adult dogs were distributed into two groups, namely GS e GP. The animals in GS were given intramuscularly (15mg/kg IM) and intravenously sufentanil (1µg/kg, IV) following levomepromazine (1mg/kg IV). Dogs in GP received the same drugs, but sufentanil was replaced by saline solution. We evaluated the heart rate (FC); systolic (PAS), diastolic (PAD) and mean (PAM) arterial pressures; respiratory rate (f); oxyhemoglobin saturation (SpO₂); end-tidal carbon dioxide concentration (ETCO₂), and rectal temperature levomepromazine was given (M15), 10 minutes after ketamine was given (M25), and 10 minutes after sufentanil or saline solution were administered (M35), as well as each 10 minutes over 20 minutes (M45 and M55). Data was submitted to variance analysis at 5% o probability. Results allowed concluding that sufentanil affects cardiovascular function, impairs ventilation and slightly reduces rectal temperature(AU)

Emprego do sufentanil em cães pré-tratados com levomepromazina e anestesiados pela cetamina / Use of sufentanil in dogs premedicated with levomepromazine and anesthezed with ketamine

O objetivo deste estudo foi avaliar as possíveis alterações cardiorrespiratórias provenientes da administração de sufentanil, em cães pré-tratados com levomepromazina e anestesiados pela cetamina. Para tanto, foram utilizados 16 cães adultos, distribuídos em dois grupos, denominados de GS e GP. Aos animais do GS, foi administrada levomepromazina (1mg/kg, IV). Decorridos 15 minutos, administrou-se cetamina (15mg/kg, IM) e após 10 minutos, sufentanil (1µg/kg, IV). Nos animais do GP foi empregada a mesma metodologia, substituindo-se o sufentanil por solução fisiológica a 0,9% (placebo). As observações das variáveis tiveram início imediatamente antes da aplicação dos fármacos (M0), 15 minutos após a administração da levomepromazina (M15), 10 minutos após a administração da cetamina (m25) e 10 minutos após a administração do sufentanil, no GS ou placebo, no GP (M35). As demais medidas foram efetuadas a intervalos de 10 minutos após M35, durante 20 minutos (M45 e M55, respectivamente). Foram estudados os seguintes parâmetros: freqüência cardíaca (FC); pressões arteriais sistólicas (PAS), diastólica (PAD) e média (PAM); freqüência respiratória (f); saturação de oxi-hemoglobina (SpO₂); concentração de dióxido de carbono ao final da expiração (ETCIO₂) e temperatura retal (TR). A avaliação estatística das variáveis foi efetuada por meio de análise de perfil a 5% de probabilidade. A análise dos resultados permitiu concluir que o sufentanil altera a função cardiovascular, por diminuí-la; prejudica a ventilação e determina discreta influência sobre a temperatura retal

This study aimed at investigating the cardiorespiratory promoted by the infusion of sufentanil in dogs premedicated with levomepromazine, and anesthetized with ketamine. For such, sixteen adult dogs were distributed into two groups, namely GS e GP. The animals in GS were given intramuscularly (15mg/kg IM) and intravenously sufentanil (1µg/kg, IV) following levomepromazine (1mg/kg IV). Dogs in GP received the same drugs, but sufentanil was replaced by saline solution. We evaluated the heart rate (FC); systolic (PAS), diastolic (PAD) and mean (PAM) arterial pressures; respiratory rate (f); oxyhemoglobin saturation (SpO₂); end-tidal carbon dioxide concentration (ETCO₂), and rectal temperature levomepromazine was given (M15), 10 minutes after ketamine was given (M25), and 10 minutes after sufentanil or saline solution were administered (M35), as well as each 10 minutes over 20 minutes (M45 and M55). Data was submitted to variance analysis at 5% o probability. Results allowed concluding that sufentanil affects cardiovascular function, impairs ventilation and slightly reduces rectal temperature