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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 -
Therapeutic Advances in Drug Safety 2023Propofol combined with alfentanil is suitable for intravenous anesthesia for day-case hysteroscopy.
BACKGROUND
Propofol combined with alfentanil is suitable for intravenous anesthesia for day-case hysteroscopy.
OBJECTIVE
To investigate the median effective dose (ED) and 95% effective dose (ED) of alfentanil compounded with propofol for day-case hysteroscopy.
DESIGN
In all, 29 patients who volunteered for painless hysteroscopy in 2022 were recruited. 1.5 mg/kg propofol was given as a sedative to all patients. The trial was conducted using the modified Dixon sequential method, with an initial dose of 10 μg/kg of alfentanil, and the subject's alfentanil dose depended on whether the prior hysteroscopy had failed, which was defined as inadequate cervical dilatation and hysteroscope placement with the patient exhibiting body movement, frowning, or a MOAA/S score >1. If the hysteroscopy failed (i.e. a positive response), the subsequent subject's alfentanil dosage was raised, and conversely (i.e. a negative response), the dose was decreased, with the adjacent dose ratio always being 1:1.2. The formal test begins with the first crossover wave and lasts until seven crossover waves materialize.
METHODS
The probit method was used to calculate the ED, ED, and corresponding 95% confidence intervals (CIs) of alfentanil compounded with propofol for hysteroscopy.
RESULTS
The ED and ED of alfentanil combined with propofol for day-case hysteroscopy were 5.701 (95% CI: 3.841-7.069) μg/kg and 8.817 (95% CI: 7.307-20.868) μg/kg, respectively.
CONCLUSION
Alfentanil at 8.817 μg/kg in conjunction with propofol is a successful and safe approach for day-case painless hysteroscopy.
TRIAL REGISTRATION
The trial registry name: Modified sequential method to determine the half-effective dose of alfentanil compounded with propofol for ambulatory hysteroscopy. The URL of registration is https://www.chictr.org.cn/showproj.html?proj=171786, where the full trial protocol can be accessed. Registration number: ChiCTR2200061619.
PubMed: 38074416
DOI: 10.1177/20420986231214992 -
Frontiers in Pharmacology 2023Deaths due to overdose of fentanyls result primarily from depression of respiration. These potent opioids can also produce muscle rigidity in the diaphragm and the...
Deaths due to overdose of fentanyls result primarily from depression of respiration. These potent opioids can also produce muscle rigidity in the diaphragm and the chest muscles, a phenomenon known as Wooden Chest Syndrome, which further limits ventilation. We have compared the depression of ventilation by fentanyl and morphine by directly measuring their ability to induce muscle rigidity using EMG recording from diaphragm and external and internal intercostal muscles, in the rat working heart-brainstem preparation. At equipotent bradypnea-inducing concentrations fentanyl produced a greater increase in expiratory EMG amplitude than morphine in all three muscles examined. In order to understand whether this effect of fentanyl was a unique property of the phenylpiperidine chemical structure, or due to fentanyl's high agonist intrinsic efficacy or its lipophilicity, we compared a variety of agonists with different properties at concentrations that were equipotent at producing bradypnea. We compared carfentanil and alfentanil (phenylpiperidines with relatively high efficacy and high to medium lipophilicity, respectively), norbuprenorphine (orvinolmorphinan with high efficacy and lipophilicity) and levorphanol (morphinan with relatively low efficacy and high lipophilicity). We observed that, agonists with higher intrinsic efficacy were more likely to increase expiratory EMG amplitude (i.e., produce chest rigidity) than agonists with lower efficacy. Whereas lipophilicity and chemical structure did not appear to correlate with the ability to induce chest rigidity.
PubMed: 38074147
DOI: 10.3389/fphar.2023.1277248 -
Journal of Clinical Medicine Nov 2023In recent years, remimazolam has gained approval for use in adult procedural sedation in both the United Kingdom and the United States, potentially offering an...
In recent years, remimazolam has gained approval for use in adult procedural sedation in both the United Kingdom and the United States, potentially offering an alternative to conventional sedatives like propofol and midazolam for procedural sedation. However, there is a limited body of literature that systematically reviews the outcomes of a remimazolam-alfentanil combination protocol for routine office-based dental procedures. The primary objective of this pilot study was to assess the occurrence of significant adverse events associated with the use of a remimazolam-alfentanil sedation protocol for adult dental procedures. Secondary outcomes included evaluating physiological responses, sedation effectiveness, patient and clinician satisfaction and the incidence of intraprocedural awareness. Notably, no significant adverse events were reported among the 25 adult subjects who received remimazolam and alfentanil, and all dental procedures were successfully completed. Patients and clinicians expressed high levels of satisfaction, and patients did not report any distressing memories associated with the dental procedure. These findings suggest that in a limited cohort, the remimazolam-alfentanil regimen appears to be well tolerated and effective for office-based dental procedures in adult patients, with a low risk of adverse events, acceptable hemodynamic effects, rapid onset and recovery and minimal intraoperative awareness. This study provides valuable insights into the potential use of the remimazolam-alfentanil combination in dental sedation practice.
PubMed: 38068360
DOI: 10.3390/jcm12237308 -
BMC Anesthesiology Oct 2023Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are often old and poor in physical fitness. The purpose of this study was to investigate the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTS
Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are often old and poor in physical fitness. The purpose of this study was to investigate the anesthetic effect of different doses of alfentanil combined with ciprofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).
METHODS
In this clinical trial, 137 patients, who were candidates for ERCP were randomly divided into three groups. Group A were given 0.15 μg/kg/min of alfentanil in maintenance stage, Group B were given 0.25 μg/kg/min and Group C were given 0.35 μg/kg/min. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) of the patients at each time point including the entry into the operation room (T0), at the beginning of surgery(T1), 10 min after surgery(T2), 20 min after surgery(T3), 30 min after surgery(T4),endoscopy withdrawal (T5) were recorded. Adverse events(including respiratory depression, body movement and hypoxemia),the dosage of ciprofol, the time of operation time and awakening were recorded.
RESULTS
Compared with Group A, MAP and HR in Group B and Group C was decreased during T1-T5 (P < 0.05). Compared with group B, MAP and HR in group C was decreased during T1-T5 (P < 0.05). Compared with Group A and Group C,the number of adverse reactions of Group B was decreased(P < 0.05). There was no statistical difference in surgical time among the three groups(P > 0.05),but a statistically significant difference in recovery time (P < 0.05).
CONCLUSION
The adverse events of alfentanil 0.25μg/kg/min combined with ciprofol were low, and the anesthetic effect was the best.
Topics: Humans; Aged; Cholangiopancreatography, Endoscopic Retrograde; Alfentanil; Heart Rate; Anesthetics; Propofol
PubMed: 37907835
DOI: 10.1186/s12871-023-02325-4