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Drug Design, Development and Therapy 2024To evaluate the effect of flumazenil antagonizing remimazolam on postoperative nausea and vomiting (PONV) after gynecologic day surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate the effect of flumazenil antagonizing remimazolam on postoperative nausea and vomiting (PONV) after gynecologic day surgery.
PATIENTS AND METHODS
141 cases of gynaecological daycase surgery patients in Weifang People's Hospital were selected, randomized into group F (flumazenil group, 71 cases) and group C (control group, 70 cases). Dexamethasone 5 mg, flurbiprofen axetil 50 mg, and droperidol 1 mg were given intravenously before induction of anesthesia in both groups. Anesthesia induction: Remimazolam 0.25mg / kg was injected within 1 minute. After the patient fell asleep, mivacurium chloride 0.2mg / kg was injected for 30 seconds and alfentanil 20ug / kg was injected for 30 seconds. Anesthesia maintenance: Remimazolam 1mg/kg/h and alfentanil 40ug/kg/h were continuously pumped by micro pump. Stopping the injection of remimazolam and alfentanil at the end of the operation. Flumazenil 0.2 mg was given to antagonize remimazolam in group F after 1 minute. Group C was given an equal volume of saline. The incidence of PONV in the postoperative PACU and over a 24-hour period, patient awakening time, and general patient information were recorded.
RESULTS
The incidence of PONV in both groups within 24 hours was 50.70% in group F was significantly higher than 32.86% in group C. The difference was statistically significant (P < 0.05). The incidence of PONV in the PACU was 5.6% in group F and 8.6% in group C. The difference was not statistically significant (p > 0.05).
CONCLUSION
Flumazenil antagonism of remimazolam increases the incidence of PONV within 24 hours in gynecologic day surgery patients and has no significant effect on the incidence of PONV in the PACU.
Topics: Female; Humans; Alfentanil; Ambulatory Surgical Procedures; Antiemetics; Benzodiazepines; Flumazenil; Gynecologic Surgical Procedures; Postoperative Nausea and Vomiting
PubMed: 38465267
DOI: 10.2147/DDDT.S444313 -
Journal of Anesthesia Jun 2024More literature studies have reported that alfentanil is safe and effective for labor analgesia. However, there is no unified consensus on the optimal dosage of... (Randomized Controlled Trial)
Randomized Controlled Trial
The 90% effective concentration of alfentanil combined with 0.075% ropivacaine for epidural labor analgesia: a single-center, prospective, double-blind sequential allocation biased-coin design.
PURPOSE
More literature studies have reported that alfentanil is safe and effective for labor analgesia. However, there is no unified consensus on the optimal dosage of alfentanil used for epidural analgesia. This study explored the concentration at 90% of minimum effective concentration (EC90) of alfentanil combined with 0.075% ropivacaine in patients undergoing epidural labor analgesia to infer reasonable drug compatibility and provide guidance for clinical practice.
METHODS
In this prospective, single-center, double-blind study, a total of 45 singleton term primiparas with vaginal delivery who volunteered for epidural labor analgesia were recruited. The first maternal was administered with 3 μg/mL alfentanil combined with 0.075% ropivacaine with the infusion of 10 mL of the mixture every 50 min at a background dose of 3 mL/h. In the absence of PCEA, a total of 15 mL of the mixture is injected per hour. The subsequent alfentanil concentration was determined on the block efficacy of the previous case, using an up-down sequential allocation with a bias-coin design. 30 min after epidural labor analgesia, the block of patient failed with visual analog score (VAS) > 3, the alfentanil concentration was increased in a 0.5 μg/mL gradient for the next patient, while the block was successful with VAS ≤ 3, the alfentanil concentration was remained or decreased in a gradient according to a randomized response list for the next patient. EC90 and 95% confidence interval were calculated by linear interpolation and prediction model with R statistical software.
RESULTS
In this study, the estimated EC90 of alfentanil was 3.85 μg/mL (95% confidence interval, 3.64-4.28 μg/mL).
CONCLUSION
When combined with ropivacaine 0.075%, the EC90 of alfentanil for epidural labor analgesia is 3.85 μg/mL in patients undergoing labor analgesia.
Topics: Humans; Ropivacaine; Female; Double-Blind Method; Alfentanil; Pregnancy; Analgesia, Epidural; Prospective Studies; Adult; Anesthetics, Local; Analgesia, Obstetrical; Analgesics, Opioid; Dose-Response Relationship, Drug; Pain Measurement
PubMed: 38441686
DOI: 10.1007/s00540-024-03322-8 -
Mikrochimica Acta Feb 2024Hundreds of thousands of people dying from the abuse of fentanyl and its analogs. Hence, the development of an efficient and highly accurate detection method is...
Hundreds of thousands of people dying from the abuse of fentanyl and its analogs. Hence, the development of an efficient and highly accurate detection method is extremely relevant and challenging. Therefore, we proposed the introduction of oxygen defects into Fe(MoO) nanoparticles for improving the catalyst performance and combining it with multi-walled carbon nanotubes (MWCNTs) for electrochemical detection of fentanyl and its analogs. Oxygen vacancy-rich Fe(MoO) (called r-Fe(MoO)) nanoparticles were successfully synthesized and characterized in detail by scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive spectrometry (EDS), X-ray diffraction (XRD), Fourier transform infrared (FT-IR), Raman spectra, BET, X-ray photoelectron spectroscopy (XPS), and electron paramagnetic resonance (EPR) and investigated by comparison with oxygen vacancy-poor Fe(MoO) (called p-Fe(MoO)). The obtained oxygen vacancy-rich Fe(MoO) was ultrasonically composited with MWCNTs for modification of glassy carbon electrodes (GCEs) used for the electrochemical detection of fentanyl and its analogs. The modified MWCNT-GCE showed ultrasensitivity to fentanyl, sufentanil, alfentanil, and acetylfentanyl with limits of detection (LOD) of 0.006 µmol·L, 0.008 µmol·L, 0.018 µmol·L, and 0.024 µmol·L, respectively, and could distinguish among the four drugs based on their peak voltages. Besides, the obtained r-Fe(MoO)/MWCNT composite also exhibited high repeatability, selectivity, and stability. It showed satisfactory detection performance on real samples, with recoveries of 70.53 ~ 94.85% and 50.98 ~ 82.54% in serum and urine for the four drugs in a concentration range 0.2 ~ 1 µM, respectively. The experimental results confirm that the introduction of oxygen vacancies effectively improves the sensitivity of fentanyl electrochemical detection, and this work provides some inspiration for the development of catalytic materials for electrochemical sensors with higher sensitivity.
PubMed: 38411763
DOI: 10.1007/s00604-024-06222-6 -
Aesthetic Surgery Journal May 2024Use of local anesthesia and conscious sedation with a combination of a sedative and anesthetic drug during a surgical procedure is an approach designed to avoid... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
BACKGROUND
Use of local anesthesia and conscious sedation with a combination of a sedative and anesthetic drug during a surgical procedure is an approach designed to avoid intubation, which produces fewer adverse events compared to general anesthesia. In the present study, a comparison was made between the efficacy and safety of remimazolam besylate and propofol for facial plastic surgery.
OBJECTIVES
The objective was to evaluate the clinical efficacy, comfort, and incidence of adverse events of remimazolam compared with propofol combined with alfentanil in outpatient facial plastic surgery.
METHODS
In this randomized, single-blind, single-center, comparative study, facial plastic surgery patients were randomly divided into remimazolam-alfentanil (n = 50) and propofol-alfentanil (n = 50) groups for sedation and analgesia. The primary endpoint was the incidence of hypoxemia, while secondary endpoints included efficacy and safety evaluations.
RESULTS
There were no significant differences regarding the surgical procedure, sedation and induction times, pain and comfort scores, muscle strength recovery, heart rate, respiratory rate, and blood pressure, but the dosage of alfentanil administered to the remimazolam group (387.5 μg) was lower than that for the propofol group (600 μg). The incidence of hypoxemia (P = .046) and towing of the mandibular (P = .028), as well as wake-up (P = .027) and injection pain (P = .008), were significantly higher in the propofol group than the remimazolam group.
CONCLUSIONS
Remimazolam and propofol had similar efficacies for sedation and analgesia during facial plastic surgery, but especially the incidence of respiratory depression was significantly lower in patients given remimazolam.
Topics: Humans; Single-Blind Method; Female; Adult; Male; Propofol; Middle Aged; Alfentanil; Face; Benzodiazepines; Hypnotics and Sedatives; Young Adult; Plastic Surgery Procedures; Anesthetics, Intravenous; Treatment Outcome; Hypoxia; Conscious Sedation; Ambulatory Surgical Procedures
PubMed: 38340328
DOI: 10.1093/asj/sjae033 -
Pharmacogenomics and Personalized... 2024The polymorphism of the gene coding mu-opioid receptor () is one of the factors contributing to the variability in the response to opioid analgesics in children. The...
INTRODUCTION
The polymorphism of the gene coding mu-opioid receptor () is one of the factors contributing to the variability in the response to opioid analgesics in children. The goal of this study is to investigate its role in association with postoperative acute pain in children of various ages.
METHODS
This prospective study analyzed 110 pediatric patients, after plastic or orthopedic surgery, who were genotyped and randomly assigned to receive fentanyl or alfentanil. Postoperative pain was rated using Numerical Rating Scale (0-10). All the patients were genotyped for () gene polymorphism.
RESULTS
School children under the age of 11 with the genotype were shown to have a higher BMI (p<0.05). Children over the age of 12 carrying G allele , had increased postoperative pain sensitivity and intensity (3.28±1.95 vs 4.91±2.17; p<0.05), as compared to allele carriers.
DISCUSSION
polymorphism may explain the variation in the perception of postoperative pain in children over the age of 12 and may be a useful predictor for adjusting the dose of analgesics, but the dose is relative to the patient's needs regardless of his genetic characteristics. In younger children, carriers of polymorphic allele may be protected from obesity, due to diminished expression.
PubMed: 38313794
DOI: 10.2147/PGPM.S443035 -
European Review For Medical and... Jan 2024This study aimed at determining the optimal dose combination of alfentanil and propofol for outpatient abortion anesthesia. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study aimed at determining the optimal dose combination of alfentanil and propofol for outpatient abortion anesthesia.
PATIENTS AND METHODS
The study was separated into two parts. In the first part, patients were to determine the median effective dose (ED50) and the 95% effective dose (ED95) of alfentanil in combination with 2.5 mg·kg-1 propofol to inhibit body movements during the abortion using the Dixon up-and-down sequential allocation method. In the second part, 170 patients were randomly divided into group C (2.0 mg·kg-1 propofol with alfentanil 12.16 μg·kg-1) and group E (2.5 mg·kg-1 propofol with its ED95) to compare the anesthetic effect. The primary outcome was the sedation level during general anesthesia. The secondary outcomes were circulation, respiratory complications, and postoperative recovery quality.
RESULTS
The ED50 and the ED95 values of alfentanil were 3.37 μg·kg-1 (95% CI: 2.58-3.97 μg·kg-1) and 4.68 μg·kg-1 (95% CI: 4.04-9.32 μg·kg-1). The frequency of deep sedation in group E was significantly higher than in group C (76.5% vs. 60%). Patients in group C showed more wakefulness even during the surgery (14.3% vs. 4.4%). The results of our exploratory analyses did not reveal differences in respiratory depression, circulatory depression, postoperative side effects, or recovery outcomes.
CONCLUSIONS
The combination of 2.5 mg·kg-1 propofol and 4.68 μg·kg-1 alfentanil produces a better sedative effect than the combination of 2.0 mg·kg-1 propofol and 12.16 μg·kg-1 alfentanil without increasing additional risks associated with anesthesia.
Topics: Pregnancy; Female; Humans; Propofol; Alfentanil; Outpatients; Prospective Studies; Double-Blind Method
PubMed: 38235864
DOI: 10.26355/eurrev_202401_34898 -
American Journal of Translational... 2023To investigate the clinical effect of propofol combined with alfentanil in vocal cord polypectomy under suspension laryngoscopy.
OBJECTIVE
To investigate the clinical effect of propofol combined with alfentanil in vocal cord polypectomy under suspension laryngoscopy.
METHODS
A total of 308 patients undergoing vocal cord polypectomy under suspension laryngoscopy in the First Affiliated Hospital of Nanchang University were included in this prospective study, and the patients were randomly divided into an observation group and a control group. Patients in the observation group received alfentanil combined with propofol, while those in the control group were anesthetized with sufentanil combined with propofol. The heart rate (HR), mean arterial pressure (MAP), real portfolio project (RPP), and Steward postanesthetic recovery scores were compared between the two groups before anesthesia induction (T0), at intubation (T1), 5 min after intubation (T2), at the time of placing suspension laryngoscopy (T3), 1 min after placing the suspension laryngoscopy (T4), 1 min after extraction of support laryngoscope (T5), and 1 min after extubation (T6). In addition, the propofol dosage and peripheral plasma levels of epinephrine (E) and norepinephrine (NE) were also compared between the groups.
RESULTS
The MAP, HR, and RPP of the patients in the observation group were higher than those in the control group at T1-T5 (all P<0.05), while there was no statistical difference at T0 and T6 (all P>0.05). The Steward postanesthetic recovery scores and the propofol dosage in the observation group were lower than those in the control group. In addition, there was a statistically significant difference in the E and NE levels between the two groups after surgery (P<0.001). There was also an interaction effect between the groups and among the time points (both P<0.001).
CONCLUSION
Alfentanil can reduce the fluctuation of hemodynamics during vocal cord polypectomy under suspension laryngoscopy, and therefore improve anesthesia effect. Simultaneously, the usage of propofol was reduced, as well as the stress levels.
CLINICAL TRIAL NUMBER
ChiCTR2100054186.
PubMed: 38186970
DOI: No ID Found -
BMC Anesthesiology Jan 2024Ciprofol is a novel intravenous sedative and anesthetic. Studies have shown that it features a rapid onset of action, a fast recovery time, slight inhibition of...
BACKGROUND
Ciprofol is a novel intravenous sedative and anesthetic. Studies have shown that it features a rapid onset of action, a fast recovery time, slight inhibition of respiratory and cardiovascular functions, and a low incidence of adverse reactions. This study aims to explore the median effective dose (ED) and the 95% effective dose (ED) of ciprofol in inhibiting responses to gastroscope insertion when combined with a low dose of alfentanil, and to evaluate its safety, to provide a reference for the rational use of ciprofol in clinical practices.
METHODS
We included 25 patients aged 18-64 years of either sex who underwent gastroscopy under intravenous general anesthesia, with a Body Mass Index (BMI) 18-28 kg/m, and an American Society of Anesthesiologists (ASA) grade I or II. In this study, the dose-finding strategy of ciprofol followed a modified Dixon's up-and-down method with an initial dose of 0.30 mg/kg and an increment of 0.02 mg/kg. Ciprofol was administered after intravenous injection of 7 µg/kg of alfentanil, and 2 min later a gastroscope was inserted. When the insertion response of one participant was positive (including body movement, coughing, and eye opening), an escalation of 0.02 mg/kg would be given to the next participant; otherwise, a de-escalation of 0.02 mg/kg would be administered. The study was terminated when negative response and positive response alternated 8 times. A Probit model was used to calculate the ED and ED of ciprofol in inhibiting responses to gastroscope insertion when combined with alfentanil. Patients' recovery time, discharge time, vital signs and occurrence of adverse reactions were recorded.
RESULTS
The ED of single-dose intravenous ciprofol injection with 7 µg/kg of alfentanil in inhibiting gastroscope insertion responses was 0.217 mg/kg, and the ED was 0.247 mg/kg. Patients' recovery time and discharge time were 11.04 ± 1.49 min and 9.64 ± 2.38 min, respectively. The overall incidence of adverse reactions was 12%.
CONCLUSION
The ED of ciprofol combined with 7 µg/kg of alfentanil in inhibiting gastroscope insertion responses was 0.217 mg/kg, and the ED was 0.247 mg/kg. Ciprofol showed a low incidence of anesthesia-related adverse events.
TRIAL REGISTRATION
http://www.chictr.org.cn (ChiCTR2200061727).
Topics: Humans; Alfentanil; Gastroscopes; Prospective Studies; Hypnotics and Sedatives; Anesthesia, Intravenous; Propofol
PubMed: 38166724
DOI: 10.1186/s12871-023-02387-4