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[PMID]: 28438447 [Au] Autor: Miner JR; Driver BE; Moore JC; Faegerstrom E; Klein L; Prekker M; Cole JB [Ad] Endereço: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States. Electronic address: Miner015@umn.edu. [Ti] Título: Randomized clinical trial of propofol versus alfentanil for moderate procedural sedation in the emergency department. [So] Source: Am J Emerg Med;35(10):1451-1456, 2017 Oct. [Is] ISSN: 1532-8171 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: STUDY OBJECTIVE: To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol. METHODS: We performed a randomized clinical trial in which adults undergoing moderate sedation in the ED received either alfentanil or propofol. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, sedation time, patient satisfaction, pain, and satisfaction. RESULTS: 108 subjects completed the trial: 52 receiving alfentanil and 56 receiving propofol. Airway or respiratory adverse events leading to an intervention were similar between the two groups: 23% for alfentanil and 20% for propofol (p=0.657). There were no serious adverse events in any group. Secondary outcomes were notably different in the rate of reported pain (48% for alfentanil, 13% for propofol) and recall (75% for alfentanil, 23% for propofol) and similar in the rate of satisfaction with the procedure (87% for alfentanil, 84% for propofol). CONCLUSION: We found a similar frequency of airway and respiratory adverse events leading to intervention between alfentanil and propofol used for moderate procedural sedation. Both agents appear safe for moderate procedural sedation. [Mh] Termos MeSH primário: Alfentanil/uso terapêutico Anestésicos Intravenosos/uso terapêutico Sedação Consciente Complicações Intraoperatórias/epidemiologia Propofol/uso terapêutico [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Idoso de 80 Anos ou mais Drenagem Serviço Hospitalar de Emergência Feminino Seres Humanos Masculino Meia-Idade Procedimentos Ortopédicos Satisfação do Paciente Adulto Jovem [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anesthetics, Intravenous); 1N74HM2BS7 (Alfentanil); YI7VU623SF (Propofol) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171006 [Lr] Data última revisão: 171006 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170426 [St] Status: MEDLINE

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[PMID]: 28296748 [Au] Autor: Lang BC; Yang CS; Zhang LL; Zhang WS; Fu YZ [Ad] Endereço: aDepartment of Pharmacy, West China Second University Hospital, Sichuan University bKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education cEvidence-Based Pharmacy Center, West China Second University Hospital dDepartment of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China. [Ti] Título: Efficacy of lidocaine on preventing incidence and severity of pain associated with propofol using in pediatric patients: A PRISMA-compliant meta-analysis of randomized controlled trials. [So] Source: Medicine (Baltimore);96(11):e6320, 2017 Mar. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Propofol injection pain was considered as one conundrum during clinical anesthesia. The systematic review about the effect of lidocaine in reducing injection pain among children has not been established. The aim of the study was to systematically evaluate the efficacy and safety of such intervention. METHODS: The literature search was performed from the inception to the May 31, 2016 in PubMed, Ovid EMBASE, and Cochrane database. All randomized controlled trials that using lidocaine for propofol injection pain in children were enrolled. The primary outcome included the incidence of injection pain and the incidence of propofol injection pain in different degrees. The data were combined to calculate the relative ratio and relevant 95% confidence interval. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. RESULTS: Data from the included 11 studies indicated that the incidence of injection pain was lower in lidocaine group than the incidence in saline control group and in propofol lipuro (medium- and long-chain triglycerides) group (pain occurrence: 22.1% in lidocaine vs 66.8% in saline, RR with 95% 0.34 [0.26, 0.43], I = 38%; 30.5% in lidocaine vs 46.9% in propofol lipuro, RR with 95% 0.68 [0.46, 1.00], I = 9%). There was no difference between lidocaine and ketamine/alfentanil both in reducing pain occurrence and in reducing pain severity (pain occurrence: 29.7% in lidocaine vs 25.8% in ketamine, RR with 95% 1.47 [0.16, 13.43], I = 94%; 31.0% in lidocaine vs 30.7% in alfentanil, RR with 95% 1.01 [0.69, 1.46], I = 11%). And the reported side effects revealed that the safety of lidocaine in pediatric patients was acceptable. CONCLUSION: Compared with ketamine and alfentanil, lidocaine would be served as one more effective treatment in consideration of its well-matched efficacy, acceptable accessibility, and reasonable safety. However, more high-quality evidences in pediatric patients are necessary. [Mh] Termos MeSH primário: Anestésicos Intravenosos/efeitos adversos Anestésicos Locais/administração & dosagem Lidocaína/administração & dosagem Dor/induzido quimicamente Dor/prevenção & controle Propofol/efeitos adversos [Mh] Termos MeSH secundário: Adolescente Alfentanil/administração & dosagem Anestésicos Intravenosos/administração & dosagem Criança Método Duplo-Cego Seres Humanos Incidência Ketamina/efeitos adversos Propofol/administração & dosagem Ensaios Clínicos Controlados Aleatórios como Assunto [Pt] Tipo de publicação: JOURNAL ARTICLE; META-ANALYSIS [Nm] Nome de substância: 0 (Anesthetics, Intravenous); 0 (Anesthetics, Local); 1N74HM2BS7 (Alfentanil); 690G0D6V8H (Ketamine); 98PI200987 (Lidocaine); YI7VU623SF (Propofol) [Em] Mês de entrada: 1703 [Cu] Atualização por classe: 170403 [Lr] Data última revisão: 170403 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170316 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000006320

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[PMID]: 28259933 [Au] Autor: Jia N; Zuo X; Guo C; Li Y; Cui J; Zhao C; Cao S; Wang C; Li R; Wu Y; Wen A [Ad] Endereço: Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China. [Ti] Título: Synergistic antinociceptive effects of alfentanil and propofol in the formalin test. [So] Source: Mol Med Rep;15(4):1893-1899, 2017 Apr. [Is] ISSN: 1791-3004 [Cp] País de publicação: Greece [La] Idioma: eng [Ab] Resumo: The present study was conducted to determine the combined analgesic effect of alfentanil and propofol in the formalin test. Diluted formalin was injected into the dorsal surface of the right hind paw in rats. Nociceptive behavior was determined by counting the number of flinches of the injected paw for 1 h after injection; a reduction in formalin­induced flinching was interpreted as an antinociceptive effect. Isobolographic analysis was used to determine the type of antinociceptive interaction (additivity, antagonism or synergism). Extracellular signal­regulated kinase (ERK) and c­fos protein levels were also detected by western blot analysis to determine the potential mechanisms of the synergistic effect. Alfentanil, propofol or an alfentanil­propofol combination had an antinociceptive effect in the formalin test. The median effective dose (ED50), value of the individual drug was also obtained. The derived theoretical ED50 for the antinociceptive effect (4.36 mg/kg) was different from the observed experimental ED50 value (2.51 mg/kg). The interaction between alfentanil and propofol that produced the antinociceptive effect was synergistic according to isobolographic analysis. Furthermore, the combination of alfentanil and propofol treatments may produce synergistically antinociceptive effects by inhibiting the phosphorylation of ERK1/2 and decreasing the expression of c­fos in the spinal cord. These results demonstrated that combined treatment, with alfentanil and propofol, produced synergistic antinociceptive effects in the formalin test and may have therapeutic potential for the treatment of acute pain. [Mh] Termos MeSH primário: Alfentanil/uso terapêutico Analgésicos/uso terapêutico Dor/tratamento farmacológico Propofol/uso terapêutico [Mh] Termos MeSH secundário: Alfentanil/farmacologia Analgésicos/farmacologia Animais Sinergismo Farmacológico MAP Quinases Reguladas por Sinal Extracelular/análise MAP Quinases Reguladas por Sinal Extracelular/metabolismo Masculino Dor/metabolismo Medição da Dor Propofol/farmacologia Proteínas Proto-Oncogênicas c-fos/análise Proteínas Proto-Oncogênicas c-fos/metabolismo Ratos Sprague-Dawley Medula Espinal/efeitos dos fármacos Medula Espinal/metabolismo [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Analgesics); 0 (Proto-Oncogene Proteins c-fos); 1N74HM2BS7 (Alfentanil); EC 2.7.11.24 (Extracellular Signal-Regulated MAP Kinases); YI7VU623SF (Propofol) [Em] Mês de entrada: 1705 [Cu] Atualização por classe: 170512 [Lr] Data última revisão: 170512 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170306 [St] Status: MEDLINE [do] DOI: 10.3892/mmr.2017.6174

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[PMID]: 27613475 [Au] Autor: Fontaine M; Latarjet J; Payre J; Poupelin JC; Ravat F [Ad] Endereço: Burn Intensive Care Unit, Saint Joseph Saint Luc Hospital, 20 Quai Claude Bernard, 69007 Lyon, France. Electronic address: mfontaine@ch-stjoseph-stluc-lyon.fr. [Ti] Título: Feasibility of monomodal analgesia with IV alfentanil during burn dressing changes at bedside (in spontaneously breathing non-intubated patients). [So] Source: Burns;43(2):337-342, 2017 Mar. [Is] ISSN: 1879-1409 [Cp] País de publicação: Netherlands [La] Idioma: eng [Ab] Resumo: INTRODUCTION: The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes. PATIENTS AND METHODS: Cohort study began after favorable opinion from local ethic committee has been collected. Patient's informed consent was collected. No fasting was required. Vital signs for patients were continuously monitored (non-invasive blood pressure, ECG monitoring, cutaneous oxygen saturation, respiratory rate) all over the process. Boluses of 500 (±250) mcg IV alfentanil were administered. A continuous infusion was added in case of insufficient analgesia. Adverse reactions were collected and pain intensity was measured throughout the dressing using a ten step verbal rating scale (VRS) ranging from 0 (no pain) to 10 (worst pain conceivable). RESULTS: 100 dressings (35 patients) were analyzed. Median age was 45 years and median burned area 10%. We observed 3 blood pressure drops, 5 oxygen desaturations (treated with stimulation without the necessity of ventilatory support) and one episode of nausea. Most of the patients (87%) were totally conscious during the dressing and 13% were awakened by verbal stimulation. Median total dose of alfentanil used was 2000µg for a median duration of 35min. Pain scores during the procedure were low or moderate (VRS mean=2.0 and maximal VRS=5). Median satisfaction collected 2h after the dressing was 10 on a ten step scale. CONCLUSION: Pain control with intravenous alfentanil alone is efficient and appears safe for most burn bedside repeated dressings in hospitalized patients. It achieves satisfactory analgesia during and after the procedure. It is now our standard analgesic method to provide repeated bedside dressings changes for burned patients. [Mh] Termos MeSH primário: Dor Aguda/tratamento farmacológico Alfentanil/uso terapêutico Analgésicos Opioides/uso terapêutico Bandagens Queimaduras/enfermagem [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Estudos de Coortes Estudos de Viabilidade Feminino Seres Humanos Infusões Intravenosas Masculino Meia-Idade Medição da Dor Satisfação do Paciente Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Analgesics, Opioid); 1N74HM2BS7 (Alfentanil) [Em] Mês de entrada: 1703 [Cu] Atualização por classe: 170314 [Lr] Data última revisão: 170314 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160911 [St] Status: MEDLINE

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[PMID]: 27973590 [Au] Autor: Tsai FF; Fan SZ; Lin YS; Huang NE; Yeh JR [Ad] Endereço: Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan. [Ti] Título: Investigating Power Density and the Degree of Nonlinearity in Intrinsic Components of Anesthesia EEG by the Hilbert-Huang Transform: An Example Using Ketamine and Alfentanil. [So] Source: PLoS One;11(12):e0168108, 2016. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Empirical mode decomposition (EMD) is an adaptive filter bank for processing nonlinear and non-stationary signals, such as electroencephalographic (EEG) signals. EMD works well to decompose a time series into a set of intrinsic mode functions with specific frequency bands. An IMF therefore represents an intrinsic component on its correspondingly intrinsic frequency band. The word of 'intrinsic' means the frequency is totally adaptive to the nature of a signal. In this study, power density and nonlinearity are two critical parameters for characterizing the amplitude and frequency modulations in IMFs. In this study, a nonlinearity level is quantified using degree of waveform distortion (DWD), which represents the characteristic of waveform distortion as an assessment of the intra-wave modulation of an IMF. In the application of anesthesia EEG analysis, the assessments of power density and DWD for a set of IMFs represent dynamic responses in EEG caused by two different anesthesia agents, Ketamine and Alfentanil, on different frequency bands. Ketamine causes the increase of power density and the decrease of nonlinearity on γ-band neuronal oscillation, which cannot be found EEG responses of group B using Alfentanil. Both agents cause an increase of power density and a decrease of nonlinearity on ß-band neuronal oscillation accompany with a loss of consciousness. Moreover, anesthesia agents cause the decreases of power density and nonlinearity (i.e. DWD) for the low-frequency IMFs. [Mh] Termos MeSH primário: Alfentanil/química Anestesia/métodos Eletroencefalografia Ketamina/química [Mh] Termos MeSH secundário: Alfentanil/administração & dosagem Algoritmos Anestesiologia Bases de Dados Factuais Seres Humanos Ketamina/administração & dosagem Monitorização Intraoperatória/métodos Neurônios/fisiologia Dinâmica não Linear Oscilometria Oximetria Reprodutibilidade dos Testes Risco Processamento de Sinais Assistido por Computador Procedimentos Cirúrgicos Operatórios [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 1N74HM2BS7 (Alfentanil); 690G0D6V8H (Ketamine) [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 170718 [Lr] Data última revisão: 170718 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161216 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0168108

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[PMID]: 27871575 [Au] Autor: Abou-Arab MH; Rostrup M; Heier T [Ad] Endereço: Department of Anesthesia, Division of Emergencies and Critical Care Medicine, Oslo University Hospital, Oslo, Norway. [Ti] Título: Dose requirements of alfentanil to eliminate autonomic responses during rapid-sequence induction with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. [So] Source: J Clin Anesth;35:465-474, 2016 Dec. [Is] ISSN: 1873-4529 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: STUDY OBJECTIVE: Opioids are integral part of anesthesia induction, but information on optimal dosing is limited. We aimed to determine doses of alfentanil needed to eliminate increases in 5 autonomic response variables (plasma concentrations of epinephrine, norepinephrine and vasopressin, arterial blood pressure [ABP], and heart rate) during rapid-sequence induction of anesthesia with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. DESIGN: Prospective, randomized, observer-blinded, interventional clinical study. SETTING: Large academic institution. PATIENTS: Eighty-four healthy patients, aged 18 to 55 years, received 1 of 7 assessor-blinded doses of alfentanil (0, 10, 20, 30, 40, 50, and 60 µg/kg) together with thiopental 4 mg/kg and rocuronium 0.6 mg/kg, administered in rapid succession (15 seconds). Laryngoscopy was initiated 40 seconds after rocuronium, and tracheal intubation was concluded within 15 seconds thereafter. MEASUREMENTS: An indwelling radial artery catheter was used for hemodynamic monitoring and blood sampling. Relationships between alfentanil dose and response variables were tested with linear regression, and the influence of covariates (sex, body weight, and age) was determined. Alfentanil dose needed to prevent increases in ABP >10% above baseline with 95% probability was estimated with logistic regression. MAIN RESULTS: Significant relationships were determined between alfentanil dose and response variables. Clinically interesting influence of covariates was not found. Alfentanil 55 µg/kg was needed to prevent increases in ABP postintubation >10% above baseline with 95% probability. One individual needed a bolus of vasopressor postintubation. CONCLUSIONS: Optimal control of autonomic responses during rapid-sequence induction was achieved with clinically relevant doses of alfentanil in healthy patients anesthetized with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. [Mh] Termos MeSH primário: Alfentanil/farmacologia Androstanóis/farmacologia Anestésicos Intravenosos/farmacologia Sistema Nervoso Autônomo/efeitos dos fármacos Fármacos Neuromusculares não Despolarizantes/farmacologia Tiopental/farmacologia [Mh] Termos MeSH secundário: Adolescente Adulto Sistema Nervoso Autônomo/fisiopatologia Relação Dose-Resposta a Droga Feminino Seres Humanos Masculino Meia-Idade Estudos Prospectivos Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Androstanols); 0 (Anesthetics, Intravenous); 0 (Neuromuscular Nondepolarizing Agents); 1N74HM2BS7 (Alfentanil); JI8Z5M7NA3 (Thiopental); WRE554RFEZ (rocuronium) [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 171116 [Lr] Data última revisão: 171116 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161123 [St] Status: MEDLINE

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[PMID]: 27787363 [Au] Autor: Hsieh CH; Lin TY; Wang TY; Kuo CH; Lin SM; Kuo HP; Lo YL [Ad] Endereço: aDepartment of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Branch bGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University cHealthcare Center, Chang Gung Memorial Hospital, Taoyuan dDepartment of Thoracic Medicine, Ton-Yen General Hospital, Hsinchu County, Taiwan. [Ti] Título: The safety and efficacy of alfentanil-based induction in bronchoscopy sedation: A randomized, double-blind, controlled trial. [So] Source: Medicine (Baltimore);95(43):e5101, 2016 Oct. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Alfentanil in combination with propofol produces a synergistic sedative effect in patients undergoing flexible bronchoscopy (FB). However, the use of this combination is controversial due to the risk of cardiopulmonary depression. The aim of this study was to evaluate the proper induction regimen of alfentanil in propofol target-controlled infusion for FB sedation. METHODS: One hundred seventy-three patients were assigned randomly into 5 regimens: Group 1 and 2, alfentanil 2.5 and 5 µg/kg, respectively, immediately before propofol administration; Group 3 and 4, alfentanil 2.5 and 5 µg/kg, respectively, 2 minutes before propofol administration; and Group 5, propofol administration alone to achieve the observer assessment of alertness and sedation scale 3∼2. The bronchoscopists, physicians in charge of sedation, and patients were blind to the regimens. Adverse events, drug dose, induction, procedure and recovery time, cough severity, and propofol injection related pain were recorded. RESULTS: The patients in groups 2 and 4 required a lower dose of propofol (P = 0.031 and 0.019, respectively) and shorter time (P = 0.035 and 0.010) than group 5 for induction. Patients in group 2 experienced more hypoxemia than those in group 5 during induction (P = 0.031). The physician in charge of sedation scored a lower severity of cough in the patients in group 4 than in groups 3 and 5. There were no differences in terms of propofol injection related pain among the groups. CONCLUSION: Alfentanil 5 µg/kg given immediately before propofol infusion cannot be recommended. Further study is required to define conclusions about alfentanil 2.5 and 5 µg/kg because of the low power rating of subgroup in the present study. [Mh] Termos MeSH primário: Alfentanil/administração & dosagem Broncoscopia/métodos Sedação Consciente/métodos [Mh] Termos MeSH secundário: Anestésicos Intravenosos/administração & dosagem Método Duplo-Cego Feminino Seguimentos Seres Humanos Masculino Meia-Idade Propofol/administração & dosagem Estudos Prospectivos Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anesthetics, Intravenous); 1N74HM2BS7 (Alfentanil); YI7VU623SF (Propofol) [Em] Mês de entrada: 1702 [Cu] Atualização por classe: 170224 [Lr] Data última revisão: 170224 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 161028 [St] Status: MEDLINE

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[PMID]: 27761556 [Au] Autor: Kilic E; Demiriz B; Isikay N; Yildirim AE; Can S; Basmaci C [Ad] Endereço: Department of Anesthesiology, Sehitkamil State Hospital, Gaziantep, Turkey. E-mail. drertugrulkilic@yahoo.com. [Ti] Título: Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients. [So] Source: Saudi Med J;37(11):1191-1195, 2016 Nov. [Is] ISSN: 0379-5284 [Cp] País de publicação: Saudi Arabia [La] Idioma: eng [Ab] Resumo: OBJECTIVES: To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP). METHODS: In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Results: Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A. CONCLUSION: Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination. [Mh] Termos MeSH primário: Alfentanil/administração & dosagem Anestésicos Intravenosos/administração & dosagem Sedação Profunda Gastroscopia Ketamina/administração & dosagem Obesidade Mórbida Propofol/administração & dosagem [Mh] Termos MeSH secundário: Adulto Anestésicos Combinados Índice de Massa Corporal Sedação Profunda/métodos Método Duplo-Cego Feminino Gastroscopia/métodos Seres Humanos Masculino Meia-Idade Satisfação do Paciente Estudos Prospectivos [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anesthetics, Combined); 0 (Anesthetics, Intravenous); 1N74HM2BS7 (Alfentanil); 690G0D6V8H (Ketamine); YI7VU623SF (Propofol) [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 170817 [Lr] Data última revisão: 170817 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161021 [St] Status: MEDLINE [do] DOI: 10.15537/smj.2016.11.14557

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[PMID]: 27725791 [Au] Autor: Kwon YS; Jang JS; Lee NR; Kim SS; Kim YK; Hwang BM; Kang SS; Son HJ; Lim SY [Ad] Endereço: Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea. [Ti] Título: A Comparison of Oxycodone and Alfentanil in Intravenous Patient-Controlled Analgesia with a Time-Scheduled Decremental Infusion after Laparoscopic Cholecystectomy. [So] Source: Pain Res Manag;2016:7868152, 2016. [Is] ISSN: 1918-1523 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: . Oxycodone, a semisynthetic opioid, has been widely used for acute and chronic pain. . The aim of this study was to compare the analgesic and adverse effects of oxycodone and alfentanil on postoperative pain after laparoscopic cholecystectomy. . This was a prospective, randomized, double-blind study. A total of 82 patients undergoing laparoscopic cholecystectomy were randomly assigned to receive either oxycodone or alfentanil using intravenous patient-controlled analgesia (PCA). PCA was administered as a time-scheduled decremental continuous infusion based on lean body mass for 48 hours postoperatively. Patients were assessed for pain with a visual analogue scale (VAS), the cumulative PCA dose, adverse effects, sedation level at 1, 4, 8, 16, 24, and 48 hours postoperatively, and satisfaction during the postoperative 48 hours. . There were no significant differences ( < 0.05) between the two groups in VAS score, cumulative PCA dose, adverse effects, sedation level at 1, 4, 8, 16, 24, and 48 hours postoperatively, and satisfaction during the postoperative 48 hours. . Our data showed that the analgesic and adverse effects of oxycodone and alfentanil were similar. Therefore, oxycodone may be a good alternative to alfentanil for pain management using intravenous PCA after laparoscopic cholecystectomy when used at a conversion ratio of 10 : 1. This trial is registered with KCT0001962. [Mh] Termos MeSH primário: Alfentanil/administração & dosagem Analgesia Controlada pelo Paciente Colecistectomia Laparoscópica/efeitos adversos Entorpecentes/administração & dosagem Oxicodona/administração & dosagem Dor Pós-Operatória/tratamento farmacológico [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Método Duplo-Cego Feminino Seres Humanos Masculino Meia-Idade Medição da Dor Dor Pós-Operatória/etiologia Estudos Prospectivos Estudos Retrospectivos Estatísticas não Paramétricas Fatores de Tempo Resultado do Tratamento Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Narcotics); 1N74HM2BS7 (Alfentanil); CD35PMG570 (Oxycodone) [Em] Mês de entrada: 1703 [Cu] Atualização por classe: 170308 [Lr] Data última revisão: 170308 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161012 [St] Status: MEDLINE

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[PMID]: 27484339 [Au] Autor: Choi YH; Kim KM; Lee SK; Kim YS; Kim SJ; Hwang WS; Chung JH [Ad] Endereço: Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, 431-796, Republic of Korea. [Ti] Título: Effects of remifentanil and remifentanil-alfentanil administration on emergence agitation after brief ophthalmic surgery in children. [So] Source: BMC Anesthesiol;16(1):50, 2016 Aug 02. [Is] ISSN: 1471-2253 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Sevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence. However, it is associated with emergence agitation (EA) in children. EA may cause injury to the child or damage to the surgical site and is a cause of stress to both caregivers and families. The efficacy of remifentanil and additional alfentanil on EA in the pediatric patients underwent ophthalmic surgery with sevofluraneanesthesiawas not well evaluated to date. This study was designed to compare the effects of remifentanil and remifentanil plus alfentanil on EA in children undergoing ophthalmic surgery with sevofluraneanesthesia. METHODS: Children (aged 3-9 years) undergoing ophthalmic surgery undersevoflurane anesthesia were randomly assigned to group S (sevoflurane alone), group R (sevofluraneandremifentanil infusion, 0.1 µg/kg/min), or group RA (sevoflurane withremifentanil infusion and intravenous injection of alfentanil 5 µg/kg 10 min before the end of surgery). Mean arterial pressure (MAP), heart rate (HR), and sevoflurane concentration were checked every 15 min after induction of anesthesia. The incidence of EA, time to extubation from discontinuation of sevoflurane inhalation, and time to discharge from the postanesthesia care unit was assessed. RESULTS: The incidence of EA was significantly lower in groups R (32 %, 11/34; P = 0.01) and RA (31 %, 11/35; P = 0.008) than group S (64 %, 21/33). The time to extubation was prolonged in group RA (11.2 ± 2.3 min; P = 0.004 and P = 0.016) compared with groups S (9.2 ± 2.3 min) andR (9.5 ± 2.4 min). MAP and HR were similar in all three groups, apart from a reduction in HR at 45 min in groups R and RA. However, the sevoflurane concentration was lower in groups R and RA than group S (P < 0.001). CONCLUSIONS: The administration of remifentanil to children undergoing ophthalmic surgery undersevoflurane anesthesia reduced the incidence of EA without clinically significant hemodynamic changes. However, the addition of alfentanil(5 µg/kg)10 min before the end of surgery provided no additional benefit compared withremifentanil alone. CLINICAL TRIAL NUMBER: NCT02486926 , June.29.2015. [Mh] Termos MeSH primário: Alfentanil/administração & dosagem Delírio do Despertar/epidemiologia Procedimentos Cirúrgicos Oftalmológicos/métodos Piperidinas/administração & dosagem [Mh] Termos MeSH secundário: Extubação Anestésicos Inalatórios/administração & dosagem Anestésicos Intravenosos/administração & dosagem Criança Pré-Escolar Método Duplo-Cego Feminino Seres Humanos Incidência Masculino Éteres Metílicos/administração & dosagem Fatores de Tempo [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anesthetics, Inhalation); 0 (Anesthetics, Intravenous); 0 (Methyl Ethers); 0 (Piperidines); 1N74HM2BS7 (Alfentanil); 38LVP0K73A (sevoflurane); P10582JYYK (remifentanil) [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 170731 [Lr] Data última revisão: 170731 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160804 [St] Status: MEDLINE [do] DOI: 10.1186/s12871-016-0213-2

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