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1.
Gan To Kagaku Ryoho ; 47(10): 1521-1523, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130755

RESUMO

Oral transmucosal fentanyl has been indicated for the management of breakthrough pain in patients with cancer. Fentanyl sublingual tablets(FST)have been approved for use in Japan since 2013. However, the optimal use of FSTs has not been well-elucidated. In this case, a 73-year-old man with rectal cancer and third lumbar vertebral metastasis was treated with 100 µg FST and 12.5 µg/h fentanyl patch every day for the management of cancer-related breakthrough pain. After receiving the fourth dose of FST, the patient was unconscious for 2 days. However, his respiration was stable. This case shows that due care should be taken while administering FSTs to patients, specifically geriatric patients with bone metastasis and hypoalbuminemia.


Assuntos
Dor Irruptiva , Neoplasias , Administração Sublingual , Idoso , Analgésicos Opioides/efeitos adversos , Dor Irruptiva/tratamento farmacológico , Estado de Consciência , Fentanila/uso terapêutico , Humanos , Japão , Masculino , Neoplasias/tratamento farmacológico , Comprimidos/uso terapêutico
2.
Medicine (Baltimore) ; 99(40): e22536, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019461

RESUMO

RATIONALE: Paroxysmal autonomic instability with dystonia (PAID) is an underdiagnosed syndrome that describes a collection of symptoms following diverse cerebral insults, such as traumatic brain injury, hydrocephalus, hemorrhagic stroke, or brain anoxia. It is manifested by systemic high blood pressure, hyperthermia, tachycardia, tachypnea, diaphoresis, intermittent agitation, and certain forms of dystonia. PATIENT CONCERNS: A semi-comatose 46-year-old man was transferred from the regional rehabilitation hospital with various complaints involving fluctuating vital signs, including uncontrolled hyperthermia, hypertension, tachycardia, and tachypnea, and dystonia in all extremities. The patient underwent brain surgery for astrocytoma in 1996. The patient also had a history of first ischemic stroke on the basal ganglia in 2008 and a second one in the same area in 2017. DIAGNOSIS: The laboratory, electrocardiography, and radiologic findings were normal. Brain imaging indicated an old infarction on the basal ganglia with hydrocephalus. Tractography using diffusion tensor imaging showed discontinuity of multiple tracts, and electrophysiologic tests, such as evoked potentials, displayed an absent response. Based on the dysautonomic symptoms and brain evaluations, the physiatrist diagnosed the patient with PAID. INTERVENTIONS: Bromocriptine, propranolol, and clonazepam were administered sequentially, but autonomic instability persisted. Then, intravenous opioid was administered, and fluctuations in body temperature, heart rate, and respiratory rate, as well as decerebrate-type dystonia were improved. However, simultaneously, drug-induced severe hypotension developed (systolic blood pressure, 57 mm Hg). Subsequently, a transdermal opioid (fentanyl) patch for PAID was applied once every 3 days. OUTCOMES: Ultimately, all vital signs and dystonia were managed without further complications, and the patient was discharged. LESSONS: A patient diagnosed with PAID following multiple cerebral insults was observed, whose condition was controlled by application of opioid patch rather than by intravenous or oral routes. A transdermal opioid patch, such as fentanyl patch, can thus be effective in the treatment of patients with PAID following multiple cerebral insults.


Assuntos
Analgésicos Opioides/uso terapêutico , Doenças do Sistema Nervoso Autônomo/tratamento farmacológico , Distonia/diagnóstico , Fentanila/uso terapêutico , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Gânglios da Base/patologia , Isquemia Encefálica/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Distonia/etiologia , Febre/diagnóstico , Febre/etiologia , Humanos , Hidrocefalia/etiologia , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipotensão/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Síndrome , Taquicardia/diagnóstico , Taquicardia/etiologia , Taquipneia/diagnóstico , Taquipneia/etiologia , Adesivo Transdérmico/efeitos adversos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(40): e22524, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019455

RESUMO

TRIAL DESIGN: The current study is a meta-analysis designed to assess the effect of adding magnesium to a combination of intrathecal bupivacaine and fentanyl. METHODS: The protocol was registered in PROSPERO with the number CRD42020177618. PubMed, Cochrane library, Web of Science, and Google Scholar were searched for randomized controlled trials investigating the effect of adding magnesium to a combination of intrathecal bupivacaine and fentanyl. The continuous data were presented as Ratio of means (RoM). Risk ratio (RR) along with 95% confidence interval (CI) was utilized to assess the dichotomous data. RESULTS: Ten trials were involved in the present study with 720 adult patients. Compared with control, intrathecal magnesium prolonged time to the first analgesic requirement by an estimate of 1.23 (RoM: 1.23; 95%CI: 1.13-1.33; P < .00001), prolonged adequate sensory block duration for surgery by an estimate of 1.16 (RoM: 1.16; 95%CI: 1.05-1.27; P = .003), delayed time to maximum sensory level by an estimate of 1.38 (RoM: 1.38; 95%CI: 1.07-1.78; P = .01) and reduced the incidence of shivering following spinal anesthesia (risk ratio: 0.38; 95%CI: 0.18 to 0.81, P = .01) without influence on time to full motor recovery or incidences of hypotention, bradycardia, nausea, and vomiting or pruritis. CONCLUSION: Intrathecal magnesium, when added to a combination of intrathecal bupivacaine and fentany, prolongs the analgesic duration of spinal anesthesia without increased incidences of side effects.


Assuntos
Raquianestesia/métodos , Anestésicos/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Analgésicos Opioides/uso terapêutico , Período de Recuperação da Anestesia , Raquianestesia/efeitos adversos , Anestésicos/administração & dosagem , Anestésicos/efeitos adversos , Bupivacaína/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Fentanila/uso terapêutico , Humanos , Sulfato de Magnésio/administração & dosagem , Sulfato de Magnésio/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tremor por Sensação de Frio/efeitos dos fármacos , Fatores de Tempo
4.
Am J Emerg Med ; 38(9): 1860-1866, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32739857

RESUMO

STUDY OBJECTIVE: To assess the efficacy and safety of intranasal analgesic-dose ketamine as compared to intranasal fentanyl for pediatric acute pain. METHODS: A systematic review and meta-analysis was performed following the PRISMA guidelines. We searched PubMed, Embase, and Scopus databases for randomized controlled trials from inception to December 2019. We conducted meta-analysis with random-effects models to evaluate pain reduction, rescue analgesia, adverse events and sedation between intranasal ketamine and intranasal fentanyl. Random-effects models were used to estimate weighted mean differences (WMD) and pooled relative risks (RR). RESULTS: A total of 546 studies were screened and 4 trials were included. In the meta-analysis of 4 studies including 276 patients, ketamine had similar reductions in pain scores from baseline to all post-intervention times (10 to 15 min: WMD -1.42, 95% CI -9.95 to 7.10; 30 min: WMD 0.40, 95% CI -6.29 to 7.10; 60 min: WMD -0.64, 95% CI -6.76 to 5.47). Ketamine was associated with similar rates of rescue analgesia (RR 0.74, 95% CI 0.44 to 1.25). Ketamine had a higher risk of non-serious adverse events (RR 2.00, 95% CI 1.43 to 2.79), and no patients receiving ketamine had a serious adverse event. There was one serious adverse event (hypotension) with fentanyl that self-resolved. No patients receiving either IN fentanyl or ketamine had significant sedation. CONCLUSION: Intranasal analgesic-dose ketamine may be considered as an alternative to opioids for acute pain management in children. Its accepted use will depend on the tolerability of non-serious adverse events and the desire to avoid opioids.


Assuntos
Dor Aguda/tratamento farmacológico , Analgésicos/uso terapêutico , Ketamina/uso terapêutico , Manejo da Dor/métodos , Administração Intranasal , Analgésicos/administração & dosagem , Criança , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Humanos , Ketamina/administração & dosagem
5.
Brasília; s.n; 29 jul. 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1117728

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos e 3 protocolos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Avaliação da Tecnologia Biomédica , Midazolam/uso terapêutico , Imunoglobulinas/uso terapêutico , Metilprednisolona/uso terapêutico , Vacinas contra Influenza/uso terapêutico , Propofol/uso terapêutico , Cloroquina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Fentanila/uso terapêutico , Estudos Transversais , Estudos de Coortes , Enoxaparina/uso terapêutico , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Cobre/uso terapêutico , Lopinavir/uso terapêutico , Resveratrol/uso terapêutico , Interferon alfa-2/uso terapêutico , Hidroxicloroquina/uso terapêutico , Ketamina/uso terapêutico
6.
Medicine (Baltimore) ; 99(22): e20298, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481399

RESUMO

Continuous epidural analgesia (CEA) using local anesthetics is frequently used to control herpes zoster pain and prevent postherpetic neuralgia (PHN). However, few studies have been conducted to determine the efficacy of epidural drugs administered as CEA to manage PHN. This retrospective study was designed to evaluate the effectiveness of CEA with ropivacaine alone or with ropivacaine and fentanyl for controlling pain caused by PHN.We reviewed the medical records of 71 patients. We studied 2 groups: epidural ropivacaine (ER; CEA with ropivacaine alone; n = 44) and epidural ropivacaine and fentanyl (Epidural ropivacaine and fentanyl (ERF); CEA with ropivacaine and fentanyl; n = 27). To evaluate pain, a numeric rating scale (NRS) was evaluated at 6 time points: immediately before the procedure (baseline NRS score); 1 hour after the procedure; 14 days after the procedure; and 1, 3, and 6 months after the procedure. Complication rates were recorded during CEA. We also investigated whether additional invasive procedures were needed due to insufficient pain control during the 6-month follow-up period.After adjusting for confounding variables, there were no significant differences in the NRS scores between the 2 groups at any time point. The adjusted odds ratio for additional invasive procedures within 6 months after CEA was 1.03-times higher in the ERF group than in the ER group, but this difference was not statistically significant (95% confidence interval: 0.33-3.23, P = .96). Rates of complication (dysuria, vomiting, nausea, itching sensation, and hypotension) during CEA were higher in the ERF group than in the ER group. However, the differences were not statistically significant.There was no difference in the management of pain in patients with PHN between the groups. Epidural administration of fentanyl with ropivacaine did not improve pain management when compared to ropivacaine alone. Although not statistically significant, the incidence of complications during CEA was higher in the opioid combination group.


Assuntos
Analgesia Epidural/métodos , Anestésicos Intravenosos/uso terapêutico , Anestésicos Locais/uso terapêutico , Fentanila/uso terapêutico , Neuralgia Pós-Herpética/tratamento farmacológico , Ropivacaina/uso terapêutico , Idoso , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Quimioterapia Combinada , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Ropivacaina/administração & dosagem , Ropivacaina/efeitos adversos
7.
Ann Palliat Med ; 9(2): 611-624, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32156127

RESUMO

Fentanyl has been FDA approval as an analgesic since 1968 and multiple different fentanyl preparations have been developed over the years. Little was known about it is clinical utility defined by risks and benefits until recently. Present commercially available preparations are easily tampered and nonpharmacologic fentanyl has become the major cause of opioid deaths in the United States. This state-ofthe-art review will discuss fentanyl pharmacology, utility, safety and abuse.


Assuntos
Analgésicos Opioides/efeitos adversos , Fentanila/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Fentanila/uso terapêutico , Humanos , Entorpecentes/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/etiologia , Saúde Pública , Estados Unidos
8.
Int J Med Sci ; 17(2): 207-213, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038104

RESUMO

Background: The incidence of postoperative nausea and vomiting (PONV) remains high. The effects of sufentanil for PONV is not firmly confirmed. The aim of this study was to compare the effect of sufentanil- and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) on the incidence of PONV after laparoscopic nephrectomy. Methods: Eighty-six patients were randomly allocated to receive either the sufentanil (n =43) or fentanyl (n =43). IV-PCA was prepared using either sufentanil 3 µg/kg or fentanyl 20 µg/kg, ramosetron 0.3 mg, and ketorolac 120 mg. The primary outcome of was the incidence of PONV during 24 h after post anesthesia care unit (PACU) discharge. The secondary outcomes were the modified Rhodes index and patient satisfaction scores at 24 h after PACU discharge, need for rescue antiemetics, pain score, need for additional analgesics, and cumulative consumption of IV-PCA Results: The incidence of PONV was comparable between the sufentanil and fentanyl groups (64.3% vs. 65%, p = 0.946; respectively). The number of patients who required antiemetics (p = 0.946) and the modified Rhodes index at 24 h after post-anesthesia care unit discharge (p = 0.668) were also comparable in both groups. No significant differences were found in the secondary outcomes, including the analgesic profiles and adverse events between the groups. Conclusions: In conclusion, sufentanil- and fentanyl-based IV-PCA showed similar incidence of PONV with comparable analgesic effects after laparoscopic nephrectomy. Based on these results, we suggest that sufentanil and fentanyl may provide comparable effects for IV-PCA after laparoscopic nephrectomy.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Fentanila/uso terapêutico , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Sufentanil/uso terapêutico , Adulto , Idoso , Método Duplo-Cego , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Estudos Prospectivos , Adulto Jovem
9.
Pediatr Neurosurg ; 55(1): 36-41, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940654

RESUMO

INTRODUCTION: Intravenous patient-controlled analgesia (PCA) has been one of the most popular modalities for postoperative pain management in orthopedic surgery, plastic surgery, or neurosurgery in children. OBJECTIVE: We compared the effects of fentanyl and sufentanil used in intravenous PCA on postoperative pain management and opioid-related side effects in pediatric moyamoya disease. METHODS: This retrospective study included 97 pediatric patients who underwent surgery for moyamoya disease. Preoperative and perioperative parameters were assessed. The PCA regimen was as follows: fentanyl group (0.2 µg/kg/mL, 1 mL of loading volume, 0.1 µg/kg/h of basal infusion, a bolus of 0.2 µg/kg on demand, "lock-out" interval of 15 min); sufen-tanil group (0.04 µg/kg/mL, 1 mL of loading volume, 0.02 µg/kg/h of basal infusion, a bolus of 0.04 µg/kg on demand, 15 min lock-out), 10 µg/kg (up to 300 µg) of ramosetron for prophylaxis of postoperative nausea and vomiting with the same loading dose in both groups. Peripheral nerve blocks were performed. Pain was assessed by numeric rating scale or revised Faces Pain Scale. Side effects were reviewed. RESULTS: The two groups showed similar pain scores and incidence of nausea or vomiting during the first 48 h postoperatively. Additional analgesics were more frequent in the fentanyl group, and PCA was discontinued more frequently in the sufentanil group. CONCLUSIONS: Postoperatively, sufen-tanil in PCA provided more analgesia than fentanyl with less additional analgesics in moyamoya disease. However, PCA with sufentanil was more frequently discontinued due to nausea or vomiting compared to fentanyl-based PCA.


Assuntos
Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Fentanila/uso terapêutico , Doença de Moyamoya/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Sufentanil/uso terapêutico , Administração Intravenosa , Adolescente , Analgésicos Opioides/efeitos adversos , Criança , Pré-Escolar , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Masculino , Náusea/etiologia , Medição da Dor , Estudos Retrospectivos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos , Vômito/etiologia
10.
Medicina (Kaunas) ; 56(1)2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31936282

RESUMO

Background and Objectives: Currently, few studies have reported the effects of opioids during continuous epidural infusion (CEI) to control pain owing to herpes zoster (HZ). This study aimed to retrospectively compare the effectiveness of epidural opioids in the treatment of acute HZ pain. Materials and Methods: We reviewed medical records of 105 patients who were divided into two groups: R group (CEI with ropivacaine) and RF group (CEI with ropivacaine and fentanyl). Clinical efficacy was evaluated using the numeric rating scale (NRS) score for 6 months after the procedures. We compared the percentage of patients with complete remission in each group. We investigated the complication rates during CEI. Results: No significant differences in the NRS scores were observed between the two groups in the 6-month period. The adjusted odds ratio (OR) for patients included in the complete remission was 0.6 times lower in the RF group than in the R group (95% confidence interval: 0.22-1.71, p = 0.35). The OR for complications during CEI was higher in the RF group than in the R group. However, the difference was not statistically significant. Conclusions: No difference was observed in the management of HZ pain and the prevention of postherpetic neuralgia between the two groups. The incidence of complications tended to be higher in the RF group than in the R group.


Assuntos
Combinação de Medicamentos , Fentanila/normas , Herpes Zoster/tratamento farmacológico , Ropivacaina/normas , Idoso , Analgesia Epidural/métodos , Analgesia Epidural/normas , Analgesia Epidural/estatística & dados numéricos , Analgésicos/normas , Analgésicos/uso terapêutico , Feminino , Fentanila/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , República da Coreia , Estudos Retrospectivos , Ropivacaina/uso terapêutico , Estatísticas não Paramétricas
11.
Support Care Cancer ; 28(2): 451-459, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31713692

RESUMO

Head and neck cancers (HNC) represent 5% of all malignancies worldwide with about 180,000 cancer deaths per year. Patients with HNC are characterized by a systemic inflammatory state, generally associated with worse outcomes. Treatment-related toxicity is common among HNC patients and causes systemic consequences such as fatigue or cognitive dysfunction. The therapeutic treatments of HNC involve the release in circulation of inflammatory systemic mediators, whose effects trigger a vicious circle that may lead to functional and behavioral alterations. The areas of the head and neck are highly sensitive to pain. Literature data confirm that in HNC patients, pain is one of the most distressing symptoms across all the phases of treatment. Pain is associated with worse general conditions, depression, fatigue, impaired cognitive functions, and lower survival rate. The treatment of advanced HNC cases is multimodal and requires a multidisciplinary psycho-socio-pharmacological approach mediated by a team of experts. The pharmacological approach in management of HNC patients with pain is fundamental and involves the use of opioids, NSAIDs, steroids, or other drugs. Opioids in pain management therapy in patients with HNC could allow the pain level to be adequately monitored, thus improving quality of life. The integration of opioid and non-opioid therapy as well as non-pharmacological interventions is essential for the rehabilitation of physical, social, and psychological functions and to achieve pain control in patients with HNC. Opioid treatment is the mainstay for pain control, being used both for background and breakthrough cancer pain (BTcP) episodes. Fentanyl, easily absorbed and generally well tolerated, appears to be a possible choice due to its versatility. Non-pharmacological interventions, such as tailored yoga, physical exercise, and acupuncture, may have a role in pain management in patients with HNC.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Fentanila/uso terapêutico , Neoplasias de Cabeça e Pescoço/patologia , Manejo da Dor/métodos , Analgésicos Opioides/administração & dosagem , Dor Irruptiva/patologia , Dor do Câncer/patologia , Depressão , Exercício Físico , Fadiga/induzido quimicamente , Fentanila/administração & dosagem , Humanos , Qualidade de Vida/psicologia
12.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 123-127, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31036701

RESUMO

OBJECTIVE: To examine changes in blood pressure (BP), cardiac output (CO) and cerebral regional oxygen saturation (rScO2) with administration of premedication for neonatal intubation. DESIGN: Pilot, prospective, observational study. Oxygen saturation, heart rate, CO, rScO2 and BP data were collected. Monitoring began 5 min prior to premedication and continued until spontaneous movement. SETTING: Single-centre, level 3 neonatal intensive care unit PATIENTS: 35 infants, all gestational ages. 81 eligible infants: 66 consented, 15 refused. INTERVENTIONS: Intravenous atropine, fentanyl or morphine, ±cisatracurium MAIN OUTCOME MEASURES: BP, CO, rScO2 RESULTS: n=37 intubations. Mean gestational age and median birth weight were 31 4/7 weeks and 1511 g. After premedication, 10 episodes resulted in a BP increase from baseline and 27 in a BP decrease. Of those whose BP decreased, 17 had <20% decrease and 10 had ≥20% decrease. Those with <20% BP decrease took an average of 2.5 min to return to baseline while those with a ≥20% BP decline took an average of 15.2 min. Three did not return to baseline by 35 min. Following intubation, further declines in BP (21%-51%) were observed in eight additional cases. One infant required a bolus for persistently low BPs. CO and rScO2 changes were statistically similar between the two groups. CONCLUSION: About 30% of infants dropped their BP by ≥20% after premedication for elective intubation. These BP changes were not associated with any significant change in rScO2 or CO. More data are needed to better characterise the immediate haemodynamic changes and clinical outcomes associated with premedication.


Assuntos
Analgésicos Opioides/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Terapia Intensiva Neonatal/organização & administração , Intubação Intratraqueal/métodos , Bloqueadores Neuromusculares/uso terapêutico , Pré-Medicação/métodos , Analgésicos Opioides/administração & dosagem , Atracúrio/análogos & derivados , Atracúrio/uso terapêutico , Peso ao Nascer , Diterpenos/uso terapêutico , Quimioterapia Combinada , Feminino , Fentanila/uso terapêutico , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/organização & administração , Masculino , Morfina/uso terapêutico , Oxigênio/sangue , Projetos Piloto , Estudos Prospectivos
13.
Ann Otol Rhinol Laryngol ; 129(1): 55-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31801377

RESUMO

OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children's hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). CONCLUSION: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.


Assuntos
Analgésicos/uso terapêutico , Anestesiologia , Anestésicos/uso terapêutico , Antieméticos/uso terapêutico , Pediatria , Padrões de Prática Médica , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Acetaminofen/uso terapêutico , Adenoidectomia , Extubação/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Dexametasona/uso terapêutico , Fentanila/uso terapêutico , Humanos , Midazolam/uso terapêutico , Morfina/uso terapêutico , Óxido Nitroso/uso terapêutico , Ondansetron/uso terapêutico , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
14.
Indian Pediatr ; 56(12): 1011-1016, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31884429

RESUMO

OBJECTIVE: To compare propofol and fentanyl to induce conscious sedation in children undergoing flexible bronchoscopy. STUDY DESIGN: Randomized controlled trial. SETTING: Pediatric Pulmonology division at a tertiary care center in Delhi, India. PARTICIPANTS: Children aged 3-15 years who underwent flexible bronchoscopy. INTERVENTION: Children received either intravenous propofol 1 mg/kg administered as a slow bolus over 1 minute followed by 2 mg/kg/hour infusion, or intravenous Fentanyl 2 µg/kg administered as a slow bolus over one minute. OUTCOMES: Primary outcome was time to achieve conscious sedation (Ramsay score 3). Secondary outcomes were need for adjuvant midazolam, physician satisfaction, level of cough, recovery features, and side-effects in the groups. RESULTS: 53 children (propofol 27, fentanyl 26) were enrolled in the study. The mean (SD) time taken to achieve Ramsay score 03 was lower in propofol than fentanyl [15.7 (4.4) s vs 206 (55) s, P<0.001]. Propofol arm had significantly higher physician satisfaction, less requirement of adjuvant midazolam, less coughing and faster regain of full consciousness. There was no difference in drug side-effects between the groups. CONCLUSIONS: Propofol has a shorter sedation induction time, less coughing during procedure, less recovery time, and better physician satisfaction compared to fentanyl for flexible bronchoscopy in children.


Assuntos
Broncoscopia/métodos , Fentanila , Hipnóticos e Sedativos , Propofol , Adolescente , Criança , Pré-Escolar , Sedação Consciente/métodos , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Fentanila/uso terapêutico , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Propofol/administração & dosagem , Propofol/efeitos adversos , Propofol/uso terapêutico , Escala Visual Analógica
15.
Psiquiatr. biol. (Internet) ; 26(3): 116-119, sept.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-191663

RESUMO

OBJETIVOS: En las últimas décadas se ha producido un aumento voraz del uso de opiáceos, con graves consecuencias en el ámbito sanitario. Consideramos necesaria la reflexión sobre el nuevo perfil de consumidores de opiáceos, con acceso desde el sistema sanitario, y las dificultades en diagnosticar el patrón de dependencia en este tipo de pacientes. Así mismo tomar conciencia de la necesidad de intervenciones multidisciplinares más tempranas y el diagnóstico de trastornos psiquiátricos comórbidos que agraven el consumo patológico. CASO CLÍNICO: Presentamos el caso de una mujer de 54 años con dependencia severa a fentanilo sublingual de 4 años de evolución tras una enfermedad neoplásica con numerosas complicaciones. Se coordina el ingreso en la unidad de psiquiatría tras varios intentos infructuosos de deshabituación a nivel ambulatorio en distintos recursos. RESULTADOS: Tras un ingreso de un mes de evolución se consigue reforzar la conciencia de enfermedad. Se inicia tratamiento sustitutivo con metadona y se deriva al CAID para seguimiento ambulatorio. CONCLUSIONES: Es necesaria la coordinación entre las distintas áreas a las que le compete este problema, con la intención de implementar medidas de screening y prevención, así como de protocolizar planes de actuación con este tipo de pacientes en los recursos más adecuados


OBJECTIVES: There has been an enormous increase in the use of opioids in the past 20 years or so, with serious consequences for the health services. We believe that reflection is required on the profile of patients who take opioids, with access from the health system, as well as the difficulties in diagnosing the dependency pattern of this type of patient. Furthermore, to be aware of the need for earlier multidisciplinary intervention and the diagnosis of comorbid psychiatric disorders that aggravate the pathological use. CLINICAL CASE: The case is presented of a 54 year-old woman with a severe dependency on sublingual fentanyl of 4 years onset, after a neoplastic disease with numerous complications. She was admitted to the Psychiatric Unit after several unsuccessful attempts to quitting the habit using different recourse at outpatient level. RESULTS: After an admission of one month, awareness of a disease was reinforced. Replacement treatment with methadone was started and she was referred to the Integrated Drug Addictions Unit for outpatient follow-up. CONCLUSIONS: Coordination is needed between the different health areas that deal with this problem. Screening and prevention measures should be implemented, as well as having a standardised action plan for these types of patients using the most appropriate resources


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fentanila/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/etiologia , Fentanila/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Dor do Câncer/tratamento farmacológico
16.
Rev. méd. panacea ; 8(3): 116-120, sept.-dic. 2019.
Artigo em Espanhol | LILACS, LIPECS | ID: biblio-1127870

RESUMO

Objetivo: El dolor agudo postoperatorio es un conjunto de percepciones sensoriales, emocionales y mentales desagradables, asociadas a respuestas autonómicas, psicológicas y conductuales, precipitadas por el acto quirúrgico. Objetivo: Generar conocimiento sobre la eficacia del fentanilo en anestesia raquídea para el dolor agudo postoperatorio. Material y métodos: Es un estudio descriptivo de búsqueda bibliografía y se ha realizado en Pubmed, Medline, Scielo, bibliotecas de universidades nacionales e internacionales. Resultados: La asociación de fentanilo a los anestésicos locales para la anestesia subaracnoidea, reduciendo la dosificación de anestésico local y manteniendo el tiempo de su recuperación y así de esta manera mejorar la calidad, la tasa de éxito de pequeñas dosis de los mismos, con ello, la incidencia de complicaciones hemodinámicas. La administración subaracnoidea de anestésicos locales y opioides, provocan eventos adversos, prurito (30 %), náuseas y vómito (25 %), retención urinaria (10-53 %), depresión respiratoria (3 %). Las diferentes dosis de fentanilo asociado a bupivacaína 0.5%, en la raquianestesia disminuyen la intensidad de dolor según EVA, en el trans-operatorio y el manejo del dolor agudo post-operatorio en los diferentes actos quirúrgicos. Conclusión: Se concluye que la asociación de bupivacaína 0,5% más fentanilo, mediante la técnica raquídea, en pacientes intervenidos quirúrgicamente, resulta eficaz, debido a que permite obtener un menor tiempo de latencia para el bloqueo con una duración prolongada, manteniendo una adecuada hemodinamia y estabilidad respiratoria, y también reduciendo el dolor postoperatorio y sus posibles reacciones adversas. (AU)


Introduction: Acute postoperative pain is a set of unpleasant sensory, emotional and mental perceptions associated with autonomic, psychological and behavioral responses precipitated by the surgical act. Objective: Generate knowledge about the efficacy of fentanyl in spinal anesthesia for acute postoperative pain. Material and methods: It is a descriptive study of literature search and has been carried out in Pubmed, Medline, Scielo, libraries of national and international universities. Results: The association of fentanyl with local anesthetics for subarachnoid anesthesia, reduces the dose of local anesthetic, without prolonging the recovery time, improving the quality, the success rate of small doses of them, with this, the incidence of hemodynamic complications. The subarachnoid administration of local anesthetics and opioids, cause adverse events, itching (30%), nausea and vomiting (25%), urinary retention (10-53%), respiratory depression (3%), all this as a result of interactions with opioid receptors at the brain level. The different doses of fentanyl associated with 0.5% bupivacaine, in spinal anesthesia reduce the intensity of pain according to EVA, in the trans-operative period and the management of acute post-operative pain in the different surgical acts. Conclusion: It is concluded that the association of 0.5% bupivacaine plus fentanyl, through the spinal technique, in surgically treated patients, is effective, since it allows to reach a shorter time of onset of the blockade and longer duration of the block, maintaining adequate hemodynamic and respiratory stability, the time it reduces acute post-operative pain and adverse reactions. (AU)


Assuntos
Humanos , Bupivacaína/uso terapêutico , Fentanila/uso terapêutico , Dor Aguda , Raquianestesia , Epidemiologia Descritiva , Estudos Prospectivos
17.
Subst Abuse Treat Prev Policy ; 14(1): 50, 2019 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711521

RESUMO

BACKGROUND: The current opioid overdose epidemic affecting communities across North America is increasingly driven by illicitly manufactured fentanyl and its related analogues. A variety of public health interventions have been implemented and scaled up, including opioid agonist treatments (OAT). While these treatments are successful for many individuals, they have a variety of limitations. It is critical to trial alternative treatments if conventional opioid agonist treatment options are not successful for a proportion of patients who use illicit fentanyl. MAIN BODY: Prescription fentanyl has been widely used for pain management. The use of transdermal fentanyl, specifically, which provides long acting and stable drug levels post-titration over several days, should be explored as an opioid agonist treatment option. The use of transdermal fentanyl for patients who use illicit fentanyl is currently being piloted in Vancouver, Canada. To address potential diversion, the patch is signed, dated, and a film dressing is applied to mitigate tampering. Evaluation outcomes are still pending, but there have been no adverse outcomes thus far and clinical improvements have been noted for many patients. This exploratory therapeutic approach should be considered across multiple settings and rigorously evaluated. CONCLUSIONS: There are known limitations to existing OAT options and there is a need to urgently evaluate alternative strategies for patients who are using illicit fentanyl not successfully treated with conventional OAT. Many patients may be attracted to, and retained in, fentanyl assisted treatment. This may be another strategy for certain patients to prevent harms caused by illicit fentanyl use, including overdose and death.


Assuntos
Fentanila/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Administração Cutânea , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Fentanila/administração & dosagem , Humanos , Adesivo Transdérmico
18.
Am Surg ; 85(10): 1155-1158, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657314

RESUMO

The utility of opioid-sparing multimodal analgesia protocols (OSMMAPs) in opioid-tolerant (OT) patients is unknown. We sought to determine the impact of a standardized OSMMAP in OT versus opioid-naïve (ON) patients after major colorectal surgery. Consecutive patients undergoing surgery before (January 2015-March 2017) and after OSMMAP implementation (April 2017-March 2018) were identified from a single-institution prospective colorectal surgery registry. OT was defined by the presence of an opioid on the preadmission medication record. Opioid use (measured in oral morphine equivalents (OMEs)) and surgical outcomes were compared between OT and ON patients pre- and post-OSMMAP. The study cohort of 201 patients included 59 OT patients (25 pre- and 34 post-OSMMAP) and 142 ON controls (34 pre- and 108 post-OSMMAP). The median age was 47.5 years (IQR 32), and 50% were male. 185 patients (92%) had a laparoscopic/robotic resection and 16 (8%) open. There were statistically significant reductions in OME required post-OSMMAP on each postoperative day (days 1 to 4) and cumulative OME for both OT and ON patients. The reduction in opioid requirements was significantly larger in OT than ON patients. We present the first study highlighting a larger opioid usage reduction in OT than in ON patients after OSMMAP implementation.


Assuntos
Analgésicos Opioides/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório , Tolerância a Medicamentos , Morfina/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/administração & dosagem , Estudos de Casos e Controles , Protocolos Clínicos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Humanos , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Avaliação de Resultados em Cuidados de Saúde , Medicação Pré-Anestésica/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Resultado do Tratamento
19.
Med Hypotheses ; 132: 109233, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606702

RESUMO

The guidelines for cardiopulmonary resuscitation (CPR) in pediatric advanced life support suggest that midazolam is the preferred agent for sedation in patients with mild hypothermia, whereas children with cardiac arrest (CA) are at a crucial stage regarding their immature nervous system. Studies have shown that midazolam may have a detrimental effect on the developmental of the pediatric nervous system. Our previous study found that midazolam induced neuronal damage after CPR in young rats. It is speculated that: midazolam causes the potential injury of neurons by inhibiting mitochondrial autophagy expression and is an important factor for the poor prognosis in children after successful CPR. This project intends to adopt the modified asphyxiant CPR model in juvenile rats. Survival rate, neurological function and histopathological changes were evaluated to determine the protective effects of appropriate sedation depth on cerebral ischemia-reperfusion injury in juvenile rats after CPR. Combined with cell biology and molecular biology related technologies, the mechanism by which the mitochondrial pinkl-parkin signaling pathway induces autophagy to inhibit neuronal apoptosis may be key factor in the protective effects of sedation depth on the brain. The aim of this study is to provide experimental evidence and elucidate the mechanisms of improvement of cerebral ischemia-reperfusion injury by sedation depth in children after successful CPR and to lay a theoretical and experimental basis for clinical treatment.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Hipnóticos e Sedativos/uso terapêutico , Hipotermia Induzida/métodos , Midazolam/uso terapêutico , Ubiquitina-Proteína Ligases/genética , Animais , Apoptose , Encéfalo , Criança , Modelos Animais de Doenças , Eletroencefalografia , Fentanila/uso terapêutico , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Modelos Cardiovasculares , Sistema Nervoso/efeitos dos fármacos , Neurônios/metabolismo , Pediatria , Prognóstico , Ratos , Traumatismo por Reperfusão , Transdução de Sinais
20.
Artigo em Inglês | MEDLINE | ID: mdl-31605587

RESUMO

INTRODUCTION: Opioid-free anesthesia (OFA) is a new anesthesiological technique, where the giving of opioids (fentanyl) is avoided in the intra- and post-operative period. This leads to reduction in the opioid-related side effects and lower pain scores in the postoperative period. MATERIALS AND METHODS: In this randomized, single-blind clinical study, 60 patients scheduled for elective laparoscopic cholecystectomy were enrolled. Half of them (30 patients) received general balanced anesthesia with fentanyl (F group-FG), and the half received opioid-free general anesthesia (OFA group-OFAG). In the post-operative period, Visual Analogue Scale (VAS) scores were followed at rest and when coughing 1 hour, 4 hrs, 8 hrs, 12 and 24 hrs after surgery. Both groups were followed by opioid requirements in the postoperative period. RESULTS: In the postoperative period, patients in the fentanyl group (FG) have higher pain scores at rest and on coughing in all analyzed timeframes compared to patients from the OFA group, but statistically significant difference was approved 1 and 24 hours after surgery. In the OFA group 24 hours after surgery none of the patients reported pain at rest and when coughing number 7, 8, 9 and 10 according to the VAS pain score. The total opioid requirement in the postoperative period was significantly higher in the fentanyl group (FG) at rest and when coughing, compared to the OFA group. CONCLUSION: Opioid-free anesthesia as a part of multimodal analgesia and a new anesthesiology technique is a safe procedure, where opioid-related negative effects in patients undergoing elective laparoscopic cholecystectomy are avoided..


Assuntos
Analgésicos Opioides/uso terapêutico , Anestesia Geral/métodos , Fentanila/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgésicos Opioides/farmacologia , Anestesia Geral/tendências , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/normas , Terapia Combinada/efeitos adversos , Feminino , Fentanila/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/estatística & dados numéricos , Estudos Prospectivos , Método Simples-Cego , Fatores de Tempo
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