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1.
Zhonghua Yi Xue Za Zhi ; 101(39): 3238-3243, 2021 Oct 26.
Artigo em Chinês | MEDLINE | ID: mdl-34689537

RESUMO

Objective: To observe the efficacy and safety of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia (PCIA) in elderly patients undergoing laparoscopic radical resection of rectal cancer and explore its impact on patients' early recovery. Methods: One hundred and ten patients undergoing laparoscopic radical resection of rectal cancer in Affiliated Cancer Hospital of Zhengzhou University from December 2020 to March 2021, were divided into two groups (n=55) using a random number table: group S received PCIA, with continuous infusion of S(+)-ketamine combined with sufentanil, while group C received PCIA, with continuous infusion of sufentanil. PCIA was initiated at the end of the surgery, and the formulations were as follows: group S, S(+)-ketamine (1.44 mg/kg), sufentanil (1.05 µg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline; group C: sufentanil (1.50 µg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline. Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of remedial analgesia, the effective compressions number of PCI during 48 h after the operation. Time to first ambulation, time to first anal exhaust, time to resume oral feeding were recorded. The occurrence of adverse effects was compared between the two groups. Results: A total of 10 patients were excluded during the study, including 4 cases of conversion to laparotomy, 3 cases of dropping out of the study, and 3 cases with operation time more than 4 hours. Finally, 50 cases in group S and 50 cases in group C completed the study. There were no significant differences in VAS scores and Ramsay sedation sores at all time points between two groups (all P>0.05). Likewise, there were also no significant differences in the number of remedial analgesia and effective compressions of PCIA during 48 h after the operation between the two groups (both P>0.05). The total dosage of sufentanil consumption in group S [(64±9) µg] was lower than that in group C [(95±12) µg] within 48 h of PCIA, with a statistically significant difference (P<0.001). Time to first ambulation in group S was (1.1±0.2) d, which was shorter than that in group C [(1.6±0.5) d], and the difference was statistically significant (P<0.001). Likewise, time to first anal exhaust in group S [(1.3±0.4) d] was shorter than that in group C [(1.8±0.6) d], with a statistically significant difference (P<0.001). Additionally, time to resume oral feeding in group S was (2.5±0.6) d, which was shorter than that in group C [(3.1±0.7) d], and there was a statistically significant difference (P<0.001). The incidence of nausea, vomiting and pruritus in group S were 4.0%, 2.0% and 0, which were lower than that in group C (16.0%, 10% and 8.0%, respectively), with statistically significant differences (all P<0.05). No case with psychiatric symptoms was found in both groups. Conclusion: When used for postoperative intravenous analgesia in elderly patients undergoing laparoscopic radical resection of rectal cancer, S(+)-ketamine combined with sufentanil can provide satisfactory analgesic effects, decrease total consumption of sufentanil and the incidence of adverse effects, and thus facilitate patients' early recovery.


Assuntos
Ketamina , Laparoscopia , Intervenção Coronária Percutânea , Neoplasias Retais , Idoso , Analgesia Controlada pelo Paciente , Humanos , Dor Pós-Operatória , Neoplasias Retais/cirurgia , Sufentanil
2.
Iran J Med Sci ; 46(4): 263-271, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34305238

RESUMO

Background: Intrathecal additive drugs are becoming increasingly common in anesthesia practice. We aimed to evaluate the additive effects of dexmedetomidine on spinal anesthesia with sufentanil in patients undergoing lower abdominal or lower limb surgery. Methods: This double-blind randomized controlled trial was performed in Mashhad, Iran, between 2017 and 2018. Sixty patients undergoing lower abdominal or lower limb surgery were randomly divided to receive 15 mg of bupivacaine and 3 µg of sufentanil (control group; n=30) or 15 mg of bupivacaine, 3 µg of sufentanil, and 10 µg of dexmedetomidine (intervention group; n=30). Outcomes, comprised of the onset and regression of sensory and motor blocks, the duration of analgesia, analgesic use, hemodynamic parameters, and side effects, were assessed. The data were analyzed in the SPSS software (version 22), using different statistical tests. A P value of less than 0.05 was considered significant. Results: The times of sensory and motor blocks reaching T10 and Bromage 3, respectively, were significantly shorter, while the times of sensory and motor regressions to S1 and Bromage 0, correspondingly, were significantly longer in the intervention group than in the control group (P<0.001). Both the frequency (P=0.006) and the dose (P<0.001) of postoperative analgesic use were significantly lower, and the duration of analgesia was significantly longer in the intervention group (P<0.001). The frequency of side effects and changes in hemodynamic parameters had no significant differences between the groups. Conclusion: The sufentanil and dexmedetomidine combination in spinal anesthesia caused the earlier onset and later regression of sensory and motor blocks, longer postoperative analgesia, and lower analgesic use without significant side effects or hemodynamic changes, which appears to be due to the combined effects of sufentanil and dexmedetomidine. Trial Registration Number: IRCT2017082833680N3.


Assuntos
Raquianestesia/normas , Dexmedetomidina/farmacologia , Sufentanil/farmacologia , Adjuvantes Anestésicos/farmacologia , Adjuvantes Anestésicos/uso terapêutico , Adulto , Raquianestesia/efeitos adversos , Raquianestesia/métodos , Dexmedetomidina/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Método Duplo-Cego , Feminino , Humanos , Hipnóticos e Sedativos/farmacologia , Hipnóticos e Sedativos/uso terapêutico , Irã (Geográfico) , Extremidade Inferior/fisiopatologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sufentanil/uso terapêutico
3.
J Cardiothorac Surg ; 16(1): 206, 2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34321062

RESUMO

BACKGROUND: To observe the effect of combining dexmedetomidine with sufentanil on postoperative analgesia in children who underwent transthoracic device closure of ventricular septal defects (VSDs) with ultrafast track anesthesia. METHODS: This was a retrospective study. Eighty-seven children who underwent transthoracic device closure of VSDs were retrospectively analyzed. Patients were divided into three groups based on the different drugs used for postoperative patient-controlled analgesia. RESULTS: No statistically significant differences in hemodynamic parameters were noted among the three groups after surgery (p > 0.05). The FLACC score in the SD2 group was significantly greater than those in the S groups and SD1 groups after surgery (p < 0.001). The Ramsay score in the S group was significantly lower than that of the SD1 and SD2 groups at 6 h (p < 0.001 and p = 0.003), 12 h (p = 0.002 and p = 0.012), and 24 h (p < 0.001 and p < 0.001) after surgery. The pressing frequency of the analgesic pump 48 h after the operation in the SD2 group was significantly greater than that in the other two groups (p < 0.05). The incidences of respiratory depression, nausea, and vomiting in the S group were significantly greater than those in the SD1 and SD2 groups (p < 0.05). CONCLUSION: The combination of 0.04 µg/kg/h dexmedetomidine and 0.04 µg/kg/h sufentanil intravenous analgesia was more effective than the other two analgesic strategies in children who underwent transthoracic device closure of ventricular septal defects (VSDs) with ultrafast track anesthesia.


Assuntos
Anestesia , Comunicação Interventricular , Analgesia Controlada pelo Paciente , Pré-Escolar , Dexmedetomidina , Feminino , Comunicação Interventricular/cirurgia , Humanos , Masculino , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Sufentanil
4.
Anaesthesiol Intensive Ther ; 53(2): 146-152, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34284552

RESUMO

INTRODUCTION: The aim of the study was to compare and evaluate the side effects (SEs) and sedation characteristics of synergistic sedation with doses of 0.25 µg kg-1 or 0.5 µg kg-1 intranasal (IN) sufentanil, and intravenous (IV) midazolam during propofol-based sedation in patients undergoing colonoscopy. MATERIAL AND METHODS: This was a prospective, randomized, double-blind study. The patients were randomly allocated into one of 3 groups: group I (n = 33) - sufentanil IN 0.5 µg kg-1; group II (n = 33) - sufentanil IN 0.25 µg kg-1; and group III (n = 33) - IN 0.9% NaCl ( placebo ) and IV 0.04 mg kg-1 midazolam. After 15 minutes, all patients received 0.5 mg kg-1 propofol intravenously. Cardiorespiratory side effects and sedation characteristics were compared. RESULTS: The propofol consumption in group III was significantly higher than in group I and II (P < 0.001). Spontaneous eye opening time was significantly longer in group III than in group I and II ( < 0.001). The patients in group III had significantly longer recovery times than patients in group I and II (P < 0.0001). Hypotension and bradycardia were not encountered during the study. The incidence of hypoxaemia was significantly greater in group III compared to other groups (P < 0.001). Pain control and endoscopist satisfaction was significantly better for group I and II than for group III (P < 0.001). CONCLUSIONS: Synergistic sedation can be achieved safely and effectively by the combination of propofol and IN sufentanil or IV midazolam for colonoscopy. However, IN sufentanil can be considered as a reasonable alternative to IV midazolam due to less respiratory depression, and better pain control and endoscopist satisfaction.


Assuntos
Midazolam , Propofol , Colonoscopia , Sedação Consciente , Humanos , Hipnóticos e Sedativos/efeitos adversos , Midazolam/efeitos adversos , Propofol/efeitos adversos , Estudos Prospectivos , Sufentanil/efeitos adversos
5.
Clin Ther ; 43(7): 1191-1200, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34108078

RESUMO

PURPOSE: Epidural analgesia in the latent phase of the first stage of labor has been recognized and accepted by anesthesiologists worldwide. However, there is no unified consensus on the exact dosage of sufentanil with the combination of ropivacaine in the induction of epidural analgesia in the early first stage of labor. In this sequential dose-finding study, the 90% effective dose (ED90) of sufentanil for epidural administration in the early first stage of labor was estimated to minimize the adverse effects of using higher doses. METHODS: Forty parturients with cervical dilatation of 2 to 4 cm who requested epidural analgesia were enrolled in this study. Parturients received 15 mL of a combination of ropivacaine 13 mg and the test dose of sufentanil. The initial dose of sufentanil in epidural administration was 1 µg, and the dose of sufentanil for the next parturient was based on the response of the preceding participant as per a biased coin up-and-down design. The primary outcome was the dose of sufentanil that resulted in successful epidural administration by maintaining the parturients' visual analog scale scores at ≤30 mm in the first 15, 30, and 45 minutes of induction. The ED90 and 95% CIs were estimated using isotonic regression methods and bootstrapping. FINDINGS: The estimated ED90 of sufentanil in epidural administration in the early first stage of labor was 1.91 µg (95% CI, 1.82-2.35 µg) in this sequential dose-finding study. IMPLICATIONS: Sufentanil at a dosage of 2 µg is recommended for the administration of epidural analgesia in parturients in the early first stage of labor. ChiCTR.org.cn identifier: 1900021683.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Trabalho de Parto , Analgésicos Opioides/efeitos adversos , Anestésicos Locais , Método Duplo-Cego , Feminino , Humanos , Gravidez , Ropivacaina , Sufentanil/efeitos adversos
6.
Pharmacology ; 106(7-8): 384-389, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34077940

RESUMO

INTRODUCTION: Sufentanil is a potent synthetic opioid used for analgesia in neonates; however, data concerning drug disposition of sufentanil and dosage regimen are sparse in this population. Therefore, the aim of the study was to explore sufentanil disposition and to propose optimal loading and maintenance doses of sufentanil in ventilated full-term neonates. METHODS: Individual sufentanil pharmacokinetic parameters were calculated based on therapeutic drug monitoring data using a 2-compartmental model. Linear regression models were used to explore the covariates. RESULTS: The median (IQR) central volume of distribution (Vdc) and clearance (CL) for sufentanil were 4.7 (4.1-5.4) L/kg and 0.651 (0.433-0.751) L/h/kg, respectively. Linear regression models showed relationship between Vdc (L) and GA (r2 = 0.3436; p = 0.0452) as well as BW (r2 = 0.4019; p = 0.0268). Median optimal sufentanil LD and MD were 2.13 (95% CI: 1.78-2.48) µg/kg and 0.29 (95% CI: 0.22-0.37) µg/kg/h, respectively. Median daily COMFORT-B (IQR) scores ranged from 6 to 23 while no significant relationship between pharmacokinetic parameters and COMFORT-B scores was found. DISCUSSION/CONCLUSION: Body weight and gestational age were found as weak covariates for sufentanil distribution, and the dosage regimen was developed for a prospective trial.


Assuntos
Analgésicos Opioides/farmacocinética , Modelos Biológicos , Respiração Artificial , Sufentanil/farmacocinética , Analgésicos Opioides/administração & dosagem , Peso Corporal , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Sufentanil/administração & dosagem , Distribuição Tecidual
7.
J Int Med Res ; 49(5): 3000605211017000, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34038198

RESUMO

OBJECTIVE: To investigate the efficacy of low-dose sufentanil for preventing shivering and visceral traction pain during cesarean section under spinal anesthesia. METHODS: This was a prospective, randomized, controlled study. A total of 112 full-term parturients who underwent elective caesarean delivery were randomly divided into two groups. Group R received 0.75% isobaric ropivacaine intrathecally and group RS received 0.75% isobaric ropivacaine plus 5 µg sufentanil intrathecally. RESULTS: There were no significant differences in the maximum sensory block time, motor block time, duration of the surgery, and heart rate, mean arterial pressure, and blood oxygen saturation before and 1, 5, and 10 minutes after spinal anesthesia, and at the end of the surgery between the two groups. Shivering was significantly more common in group R (n = 30) than in group RS (n = 8). The incidence of visceral traction pain in group R (46.43%) was significantly higher than that in group RS (14.29%). There was no significant difference in the newborns' Apgar scores between the groups. CONCLUSION: Adding low-dose sufentanil to ropivacaine can significantly reduce the incidence of shivering and visceral traction pain after spinal anesthesia.


Assuntos
Anestesia Obstétrica , Raquianestesia , Adjuvantes Anestésicos , Amidas , Raquianestesia/efeitos adversos , Anestésicos Locais , Cesárea , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido , Dor , Gravidez , Estudos Prospectivos , Ropivacaina , Tremor por Sensação de Frio , Sufentanil , Tração
8.
Clin Ther ; 43(6): 1020-1028, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33952398

RESUMO

PURPOSE: To evaluate the outcomes of the different drug combination and infusion techniques for patient-controlled analgesia (PCA). METHODS: Ninety-seven patients who had undergone spinal tumor surgery were randomized to 4 groups with different PCA drugs and infusion techniques: subcutaneous sufentanil (SS) group; (n=25), subcutaneous sufentanil and dexmedetomidine (SDS) group (n=24), intravenous sufentanil (SI) group (n=23), and intravenous sufentanil and dexmedetomidine (SDI) group (n=25). The primary outcome measured the cumulative amount of sufentanil delivered to the patients through PCA 24 and 48 hours after the surgery. Secondary outcomes measured the visual analog scale pain scores 24 and 48 hours after the surgery, Pittsburgh Sleep Quality Index before and 1 month after surgery, Athens Insomnia Score before and the first 2 nights after surgery, and the rate of adverse events within 48 hours after surgery. FINDINGS: At 24 and 48 hours after surgery, the cumulative amount of sufentanil in the SDS group (mean [SD], 76.44 [10.75] at 24 hours and 151.96 [20.92] at 48 hours) and the SDI group (mean [SD], 75.08 [9.00] at 24 hours and 149.56 [18.22] at 48 hours) were significantly lower than in SS group (mean [SD] 95.52 [12.40] at 24 hours and 183.23 [23.06] at 48 hours) and the SI group (mean [SD], 97.25 [10.80] at 24 hours and 186.67 [20.14] at 48 hours; P < 0.001). The visual analog scale pain scores and Athens Insomnia Scale scores were also lower in the SDS and SDI groups than in the SS and SI groups 24 and 48 hours after surgery (P < 0.05). The Pittsburgh Sleep Quality Index was lower in the SDS and SDI groups 1 month after surgery. Lastly, the rate of nausea and vomiting was higher in the SI group than in the SS, SDS, and SDI groups (P = 0.018). IMPLICATIONS: Dexmedetomidine in PCA could decrease sufentanil intake and improve analgesic effect and sleep quality. Subcutaneous PCA can provide the same benefit with a lower rate of nausea and vomiting. ClinicalTrials.gov identifier: NCT04111328.


Assuntos
Analgésicos não Narcóticos , Dexmedetomidina , Preparações Farmacêuticas , Neoplasias da Coluna Vertebral , Analgesia Controlada pelo Paciente , Analgésicos Opioides , Dexmedetomidina/efeitos adversos , Método Duplo-Cego , Humanos , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Sufentanil/efeitos adversos
9.
J Comp Eff Res ; 10(9): 743-750, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33880939

RESUMO

Aim: To evaluate the usability and satisfaction from the sufentanil sublingual tablet system analgesia in the Enhanced Recovery After Surgery pathway in patients, nurses and physical therapist. Materials & methods: A system usability scale was used to evaluate analgesia system in the prospective observational study in spine, orthopedic and thoracic patients. Result: In 111 cases the median system usability scale score was 90 (80-100) (patients) and 72.5 (57.5-82.5) (nurses). The median satisfaction score of the physiotherapist was 90 (75-100). Conclusion: The usability and the satisfaction of the patients and the caregivers from sufentanil sublingual tablet system analgesia in the context of Enhanced Recovery After Surgery protocol were good-to-excellent. The economic potential in the reduction of hospital stay should be studied. Trial registration number: NCT03373851 (ClinicalTrial.gov).


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Sufentanil , Administração Sublingual , Analgesia Controlada pelo Paciente , Analgésicos Opioides , Humanos , Dor Pós-Operatória/tratamento farmacológico , Sufentanil/uso terapêutico , Comprimidos/uso terapêutico
10.
J Cardiothorac Surg ; 16(1): 102, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882970

RESUMO

BACKGROUND: There are no studies on the use of dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia (PCIA) in females undergoing thoracic surgery. We postulate that introducing dexmedetomidine to a combination of dezocine-based PCA drugs and sufentanil will increase female patients' global satisfaction degree. METHODS: One hundred fifty-two female patients with physical classification type I or II according to the American Society of Anesthesiologists undergoing thoracoscopic surgery were arbitrarily classified into two categories, either receiving sufentanil and dezocine-based PCIA (group C) or incorporating dexmedetomidine with sufentanil and dezocine-based PCIA (group D). The patients' global satisfaction degree, postoperative nausea and vomiting (PONV), PCA bolus, rescue analgesia requirements, drug-related adverse effects, rest and coughing visual analogue scale (VAS) ratings, and Ramsay sedation scores (RSS) were measured at 6, 12, 24, 36 and 48 h after surgery. RESULTS: Compared with the C group, the patient satisfaction degree was significantly higher; pain scores at rest and coughing were significantly different at 6, 12, 24, 36 and 48 h postoperatively; less rescue analgesia and PCA bolus were required; and a lower incidence of PONV was found in the D group. There were non-significant trends for the sedation scores and drug-related adverse effects in both groups. CONCLUSIONS: Dexmedetomidine combined with sufentanil and dezocine increased female patients' global satisfaction degree after thoracoscopic surgery. This effect could be linked to the improvement in postoperative analgesia and reduction in postoperative nausea and vomiting; the combined treatment did not increase drug-related adverse effects in female patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry number, ChiCTR2000030429 . Registered on March 1, 2020.


Assuntos
Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Dexmedetomidina/administração & dosagem , Dor Pós-Operatória/cirurgia , Satisfação do Paciente , Sufentanil/administração & dosagem , Tetra-Hidronaftalenos/administração & dosagem , Adulto , Analgesia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Toracoscopia , Fatores de Tempo , Resultado do Tratamento , Escala Visual Analógica
11.
J Cardiothorac Surg ; 16(1): 111, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892771

RESUMO

OBJECTIVE: To compare the safety and efficacy of dexmedetomidine and remifentanil with sufentanil-based general anesthesia for the transthoracic device closure of ventricular septal defects (VSDs) in pediatric patients. METHODS: A retrospective analysis was performed on 60 children undergoing the transthoracic device closure of VSDs from January 2019 to June 2020. The patients were divided into two groups based on different anesthesia strategies, including 30 cases in group R (dexmedetomidine- and remifentanil-based general anesthesia) and 30 cases in group S (sufentanil-based general anesthesia). RESULTS: There was no significant difference in preoperative clinical information, hemodynamics before induction and after extubation, postoperative pain scores, or length of hospital stay between the two groups. However, the hemodynamic data of group R were significantly lower than those of group S at the time points of anesthesia induction, skin incision, thoracotomy, incision closure, and extubation. The amount of intravenous patient-controlled analgesia (PCA), the duration of mechanical ventilation, and the length of the intensive care unit (ICU) stay in group R were significantly less than those in group S. CONCLUSION: Dexmedetomidine combined with remifentanil-based general anesthesia for the transthoracic device closure of VSDs in pediatric patients is safe and effective.


Assuntos
Dexmedetomidina/uso terapêutico , Comunicação Interventricular/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Remifentanil/uso terapêutico , Respiração Artificial/métodos , Sufentanil/uso terapêutico , Analgesia Controlada pelo Paciente/métodos , Anestesia Geral , Criança , Pré-Escolar , Feminino , Hemodinâmica , Humanos , Lactente , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos
12.
Braz J Anesthesiol ; 71(5): 558-564, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33901551

RESUMO

BACKGROUND AND OBJECTIVES: The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during propofol anesthesia. METHODS: 27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 µg.mL-1. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35, and 30 mmHg EtCO2 for 5 minutes, respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded. RESULTS: Systemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained during propofol anesthesia. CONCLUSIONS: Propofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular CO2 reactivity. According to our measurements, propofol may exert its systemic hemodynamic effect through venodilation. TRIAL REGISTRATION: The study was registered at http://www.clinicaltrials.gov, identifier: NCT02203097, registration date: July 29, 2014.


Assuntos
Propofol , Anestesia Geral , Anestesia Intravenosa , Anestésicos Intravenosos/farmacologia , Dióxido de Carbono , Circulação Cerebrovascular , Homeostase , Humanos , Propofol/farmacologia , Sufentanil/farmacologia
13.
J Cardiothorac Vasc Anesth ; 35(11): 3288-3293, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33836963

RESUMO

OBJECTIVES: Patients undergoing subcutaneous implantable cardioverter-defibrillator (S-ICD) placement usually experience substantial perioperative pain. The aim of the present study was to investigate the effect of transversus thoracic muscle plane block combined with serratus anterior plane block in patients undergoing S-ICD placement. DESIGN: Double-blind, randomized controlled study. SETTING: First Affiliated Hospital of Nanchang University. PARTICIPANTS: Patients aged 18-to-80 years who underwent new S-ICD placement. INTERVENTIONS: A group of 80 patients randomly were allocated to either the regional group (R group) or local group (L group). MEASUREMENTS AND MAIN RESULTS: The primary endpoint was pain during S-ICD placement. The secondary outcome measures included pain intensity at rest and after movement one, three, six, 12, 24, and 48 hours after surgery; the dose of dexmedetomidine and remifentanil during surgery; 24-hour ketorolac administration; postoperative sufentanil dosage; the total duration of hospitalization; intraoperative sedation; and the incidence of hypoxemia. Mean Critical-Care Pain Observation Tool scores were significantly higher during pocket creation, lead tunneling A, and lead tunneling B in the L group compared with the R group. The R group required significantly less intraoperative dexmedetomidine, intraoperative remifentanil, postoperative sufentanil, and ketorolac consumption. Compared with the R group, the L group had higher Numerical Rating Scale pain scores at 24 hours after surgery both at rest and after movement. The intraoperative Ramsay score and the incidence of hypoxemia were significantly higher in the L group compared with the R group. CONCLUSIONS: Ultrasound-guided transversus thoracic muscle plane block and serratus anterior plane block resulted in lower intraoperative Critical-Care Pain Observation Tool scores and the need for less adjunctive pain medication and sedation compared with local anesthesia in patients undergoing S-ICD placement.


Assuntos
Desfibriladores Implantáveis , Bloqueio Nervoso , Analgésicos , Humanos , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Sufentanil , Ultrassonografia de Intervenção
14.
J Int Med Res ; 49(4): 300060521999534, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33827306

RESUMO

OBJECTIVE: α2­agonists and opioids have been used as intrathecal adjuvants to local anesthetics for several years, but the effect of intrathecal dexmedetomidine (Dex) or sufentanil combined with epidural ropivacaine in labor analgesia is not fully understood. METHODS: A total of 108 parturient women receiving combined spinal-epidural labor analgesia were randomly divided into three groups. Group C received l mL saline (0.9%) intrathecally, Group D received 5 µg Dex intrathecally, and Group S received 5 µg sufentanil intrathecally. All parturient women then received 0.1% epidural ropivacaine and 0.2 µg/mL sufentanil for patient-controlled epidural analgesia with standard settings. The visual analog scale score, onset time, duration of intrathecal injection, local anesthetic requirements, and side effects were recorded. RESULTS: The labor analgesia effects in Groups D and S were better than those in Group C. Groups D and S displayed significantly shorter onset times, longer durations of intrathecal injection, and reduced local anesthetic requirements compared with Group C. The incidence of shivering and pruritus in Group D was lower than that in Group S. CONCLUSION: Intrathecal administration of 5 µg Dex could improve epidural labor analgesia effects.This randomized controlled clinical trial was registered with the Chinese Clinical Registry Center (ChiCTR-1800014943, http://www.chictr.org.cn/).


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Dexmedetomidina , Analgésicos Opioides , Anestésicos Locais , Método Duplo-Cego , Feminino , Humanos , Medição da Dor , Gravidez , Sufentanil
15.
Clin J Pain ; 37(6): 437-442, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33758132

RESUMO

OBJECTIVES: The addition of a small dose of opioids during epidural labor analgesia can enhance the local analgesic effect, reduce the dose of local anaesthetic required, and minimize motor blockade. For the treatment of visceral pain, studies have shown that κ-opioid receptor agonist are more effective than µ-receptor agonists. This study compared the effectiveness of epidural nalbuphine and sufentanil in combination with ropivacaine for labor analgesia, respectively. MATERIALS AND METHODS: We conducted a prospective, randomized, double-blind, multicentre clinical trial. Parturients who requested labor pain relief were randomly assigned to either the nalbuphine group or sufentanil group. After 5 minutes of initial dose, parturients in nalbuphine group received 10 mL 0.1% ropivacaine plus 0.3 mg/mL nalbuphine solution. The sufentanil group received the same ropivacaine dose plus 0.3 µg/mL sufentanil. The primary outcome was the duration of analgesia (the time to the first requirement for additional medication). Secondary outcomes included the ropivacaine dose per hour, and adverse reactions. RESULTS: Between November 2018 and February 2019, 180 parturients were recruited for the study. The study showed that the duration of analgesia was shorter in the nalbuphine group as compared with the sufentanil group (P=0.040). The ropivacaine dose per hour in nalbuphine group 9.3 (2.4) mg was significantly greater versus sufentanil group 8.4 (2.5) mg (P=0.024). No serious adverse events directly associated with the analgesics were observed. DISCUSSION: The analgesia effects of 0.3 mg/mL nalbuphine with ropivacaine are inferior to 0.3 µg/mL sufentanil with ropivacaine in labor analgesia. No serious side effects, either in the mother or in the fetus, were observed.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Dor do Parto , Nalbufina , Amidas , Analgésicos Opioides , Anestésicos Locais , Método Duplo-Cego , Feminino , Humanos , Gravidez , Estudos Prospectivos , Ropivacaina , Sufentanil
16.
Cochrane Database Syst Rev ; 3: CD013732, 2021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33729556

RESUMO

BACKGROUND: Mechanical ventilation is a potentially painful and discomforting intervention that is widely used in neonatal intensive care. Newborn infants demonstrate increased sensitivity to pain, which may affect clinical and neurodevelopmental outcomes. The use of drugs that reduce pain might be important in improving survival and neurodevelopmental outcomes. OBJECTIVES: To determine the benefits and harms of opioid analgesics for neonates (term or preterm) receiving mechanical ventilation compared to placebo or no drug, other opioids, or other analgesics or sedatives. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 9), in the Cochrane Library; MEDLINE via PubMed (1966 to 29 September 2020); Embase (1980 to 29 September 2020); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 29 September 2020). We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials comparing opioids to placebo or no drug, to other opioids, or to other analgesics or sedatives in newborn infants on mechanical ventilation. We excluded cross-over trials. We included term (≥ 37 weeks' gestational age) and preterm (< 37 weeks' gestational age) newborn infants on mechanical ventilation. We included any duration of drug treatment and any dosage given continuously or as bolus; we excluded studies that gave opioids to ventilated infants for procedures. DATA COLLECTION AND ANALYSIS: For each of the included trials, we independently extracted data (e.g. number of participants, birth weight, gestational age, types of opioids) using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria and assessed the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) for categorical data and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included 23 studies (enrolling 2023 infants) published between 1992 and 2019. Fifteen studies (1632 infants) compared the use of morphine or fentanyl versus placebo or no intervention. Four studies included both term and preterm infants, and one study only term infants; all other studies included only preterm infants, with five studies including only very preterm infants. We are uncertain whether opioids have an effect on the Premature Infant Pain Profile (PIPP) Scale in the first 12 hours after infusion (MD -5.74, 95% confidence interval (CI) -6.88 to -4.59; 50 participants, 2 studies) and between 12 and 48 hours after infusion (MD -0.98, 95% CI -1.35 to -0.61; 963 participants, 3 studies) because of limitations in study design, high heterogeneity (inconsistency), and imprecision of estimates (very low-certainty evidence - GRADE). The use of morphine or fentanyl probably has little or no effect in reducing duration of mechanical ventilation (MD 0.23 days, 95% CI -0.38 to 0.83; 1259 participants, 7 studies; moderate-certainty evidence because of unclear risk of bias in most studies) and neonatal mortality (RR 1.12, 95% CI 0.80 to 1.55; 1189 participants, 5 studies; moderate-certainty evidence because of imprecision of estimates). We are uncertain whether opioids have an effect on neurodevelopmental outcomes at 18 to 24 months (RR 2.00, 95% CI 0.39 to 10.29; 78 participants, 1 study; very low-certainty evidence because of serious imprecision of the estimates and indirectness). Limited data were available for the other comparisons (i.e. two studies (54 infants) on morphine versus midazolam, three (222 infants) on morphine versus fentanyl, and one each on morphine versus diamorphine (88 infants), morphine versus remifentanil (20 infants), fentanyl versus sufentanil (20 infants), and fentanyl versus remifentanil (24 infants)). For these comparisons, no meta-analysis was conducted because outcomes were reported by one study. AUTHORS' CONCLUSIONS: We are uncertain whether opioids have an effect on pain and neurodevelopmental outcomes at 18 to 24 months; the use of morphine or fentanyl probably has little or no effect in reducing the duration of mechanical ventilation and neonatal mortality. Data on the other comparisons planned in this review (opioids versus analgesics; opioids versus other opioids) are extremely limited and do not allow any conclusions. In the absence of firm evidence to support a routine policy, opioids should be used selectively - based on clinical judgement and evaluation of pain indicators - although pain measurement in newborns has limitations.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Processual/prevenção & controle , Respiração Artificial/efeitos adversos , Analgésicos Opioides/efeitos adversos , Viés , Desenvolvimento Infantil/efeitos dos fármacos , Fentanila/efeitos adversos , Fentanila/uso terapêutico , Heroína/efeitos adversos , Heroína/uso terapêutico , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Midazolam/efeitos adversos , Midazolam/uso terapêutico , Morfina/efeitos adversos , Morfina/uso terapêutico , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Remifentanil/efeitos adversos , Remifentanil/uso terapêutico , Respiração Artificial/estatística & dados numéricos , Sufentanil/efeitos adversos , Sufentanil/uso terapêutico
17.
J Int Med Res ; 49(3): 300060521996143, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33730928

RESUMO

BACKGROUND: Sufentanil-induced cough (SIC) is a common complication during anesthesia induction. We explored the recommended sufentanil dose that effectively avoids cough during general anesthesia using a clinical trial to analyze the effective dose (ED)50 and ED95 of sufentanil that avoids cough, hemodynamic fluctuations, and adverse reactions. METHODS: On the basis of sufentanil dose, 136 patients (ASA class I-II) were randomly allocated into the following groups: I, 0.1 µg/kg; II, 0.3 µg/kg; III, 0.5 µg/kg; or IV, 1.0 µg/kg. The number of coughing incidents, dizziness, panic, and chest tightness within 1 minute after sufentanil injection, and the patient's heart rate (HR) and blood pressure 5 minutes after intubation were recorded and analyzed. Cough was assessed as follows: none, 0 times; mild, 1 to 2 times/minute; moderate, 3 to 4 times/minute; and severe, 5 times/minute or more. RESULTS: The ED50 and ED95 of cough incidence induced by intravenous sufentanil in patients during general anesthesia induction was 0.332 µg/kg and 1.423 µg/kg, respectively. The cough rate in group I was lower than the other groups. The incidence of dizziness, panic, chest tightness, hypertension, bradycardia, and tachycardia were not significantly different. CONCLUSIONS: The recommended sufentanil dose during general anesthesia induction is 0.1 µg/kg.


Assuntos
Tosse , Sufentanil , Anestesia Geral/efeitos adversos , Tosse/induzido quimicamente , Tosse/prevenção & controle , Frequência Cardíaca , Hemodinâmica , Humanos , Sufentanil/efeitos adversos
18.
J Int Med Res ; 49(2): 300060520986351, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33535837

RESUMO

OBJECTIVES: To investigate the mechanisms underlying the protective effect of sufentanil against acute lung injury (ALI). MATERIAL AND METHODS: Rats were administered lipopolysaccharide (LPS) by endotracheal instillation to establish a model of ALI. LPS was used to stimulate BEAS-2B cells. The targets and promoter activities of IκB were assessed using a luciferase reporter assay. Apoptosis of BEAS-2B cells was evaluated by terminal deoxynucleotidyl transferase dUTP nick end labeling. RESULTS: Sufentanil treatment markedly reduced pathological changes in lung tissue, pulmonary edema and secretion of inflammatory factors associated with ALI in vivo and in vitro. In addition, sufentanil suppressed apoptosis induced by LPS and activated NF-κB both in vivo and in vitro. Furthermore, upregulation of high mobility group box protein 1 (HMGB1) protein levels and downregulation of miR-129-5p levels were observed in vivo and in vitro following sufentanil treatment. miR-129-5p targeted the 3' untranslated region and its inhibition decreased promoter activities of IκB-α. miR-129-5p inhibition significantly weakened the protective effect of sufentanil on LPS-treated BEAS-2B cells. CONCLUSION: Sufentanil regulated the miR-129-5p/HMGB1 axis to enhance IκB-α expression, suggesting that sufentanil represents a candidate drug for ALI protection and providing avenues for clinical treatment.


Assuntos
Lesão Pulmonar Aguda , MicroRNAs , Lesão Pulmonar Aguda/induzido quimicamente , Lesão Pulmonar Aguda/tratamento farmacológico , Lesão Pulmonar Aguda/genética , Animais , Lipopolissacarídeos/toxicidade , MicroRNAs/genética , NF-kappa B/genética , Ratos , Sufentanil
19.
Eur J Med Res ; 26(1): 4, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422129

RESUMO

BACKGROUND: Intravenous opioids are administered for the management of visceral pain after laparoscopic surgery. Whether oxycodone has advantages over other opioids in the treatment of visceral pain is not yet clear. METHODS: In this study, the analgesic efficiency and adverse events of oxycodone and other opioids, including alfentanil, sufentanil, fentanyl, and morphine, in treating post-laparoscopic surgery visceral pain were evaluated. This review was conducted according to the methodological standards described in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The PubMed, Embase, and Cochrane databases were searched in December 2019. RESULTS: Ten studies were included in this review. The sample size was 695 participants. The results showed that compared with morphine and fentanyl, oxycodone had a more potent analgesic efficacy on the first day after laparoscopic surgery, especially during the first 0.5 h. There was no significant difference in sedation between the two groups. Compared to morphine and fentanyl, oxycodone was more likely to lead to dizziness and drowsiness. Overall, patient satisfaction did not differ significantly between oxycodone and other opioids. CONCLUSIONS: Oxycodone is superior to other analgesics within 24 h after laparoscopic surgery, but its adverse effects should be carefully considered.


Assuntos
Laparoscopia/métodos , Oxicodona/efeitos adversos , Manejo da Dor , Dor/tratamento farmacológico , Alfentanil/efeitos adversos , Alfentanil/uso terapêutico , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Fentanila/efeitos adversos , Fentanila/uso terapêutico , Humanos , Morfina/efeitos adversos , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Dor/patologia , Sufentanil/efeitos adversos , Sufentanil/uso terapêutico
20.
Medicine (Baltimore) ; 100(1): e24160, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429798

RESUMO

ABSTRACT: Postoperative delirium (PODE) can be associated with severe clinical complications; therefore, preventive measures are important. The objective of this trial was to elucidate whether haemodynamic or electroencephalographic (EEG) monitoring parameters during general anaesthesia or sevoflurane dosage correlate with the incidence of PODE. In addition, sevoflurane dosages and EEG stages during the steady state of anaesthesia were analyzed in patients of different ages.Eighty adult patients undergoing elective abdominal surgery received anaesthesia with sevoflurane and sufentanil according to the clinical routine. Anaesthesiologists were blinded to the EEG. Haemodynamic parameters, EEG parameters, sevoflurane dosage, and occurrence of PODE were analyzed.Thirteen patients (4 out of 33 women, 9 out of 47 men) developed PODE. Patients with PODE had a greater mean arterial pressure (MAP) variance (267.26 (139.40) vs 192.56 (99.64) mmHg2, P = .04), had a longer duration of EEG burst suppression or suppression (27.09 (45.32) vs 5.23 (10.80) minutes, P = .03), and received higher minimum alveolar sevoflurane concentrations (MAC) (1.22 (0.22) vs 1.09 (0.17), P = .03) than patients without PODE. MAC values were associated with wide ranges of EEG index values representing different levels of hypnosis.The results suggest that, in order to prevent PODE, a great variance of MAP, higher doses of sevoflurane, and deep levels of anaesthesia should be avoided. Titrating sevoflurane according to end-tidal gas monitoring and vital signs can lead to unnecessarily deep or light hypnosis. Intraoperative EEG monitoring may help to prevent PODE.


Assuntos
Delírio/classificação , Delírio/etiologia , Monitorização Intraoperatória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/uso terapêutico , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/estatística & dados numéricos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Sevoflurano/efeitos adversos , Sevoflurano/uso terapêutico , Sufentanil/efeitos adversos , Sufentanil/uso terapêutico
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