Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgical stress and general anesthesia can suppress immune function and thus may increase postsurgical infections and tumor metastasis. We previously reported that two narcotics commonly used in high-dose opiate anesthesia (fentanyl and sufentanil) suppress natural killer (NK) cell activity in rats. Such doses of narcotics also cause respiratory depression accompanied by hypoxia, hypercarbia, and acidosis, which might account for the observed narcotic-induced NK suppression. In the present study, we compared the effects of fentanyl on NK activity in ventilated and non-ventilated rats. Fentanyl significantly suppressed NK cell activity to the same magnitude in the two groups, although the groups significantly differed in CO2 and O2 levels. The fact that high-dose fentanyl-induced NK suppression can be demonstrated in ventilated rats accentuates the relevance of these findings to clinical studies showing NK suppression in the immediate postoperative period. Such immunosuppression could be a risk factor for patients undergoing surgery, especially in cancer-related operations.
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PMID:Narcotic-induced suppression of natural killer cell activity in ventilated and nonventilated rats. 164 47

We have measured haemodynamic changes and plasma concentrations of catecholamines during sufentanil-nitrous oxide and fentanyl-nitrous oxide anaesthesia in a controlled, randomized, double-blind study of 20 geriatric patients (age 65-86 yr) undergoing major abdominal surgery. Fentanyl 7 micrograms kg-1 followed by infusion of 3 micrograms kg-1 h-1 was compared with sufentanil 1 micrograms kg-1 followed by 0.4 micrograms kg-1 h-1. The opioid was supplemented with 60-67% nitrous oxide in oxygen. Haemodynamic changes, plasma concentrations of catecholamines (by high pressure liquid chromatography) and opioids (by radioimmunoassay), and myocardial lactate extraction were measured in the awake state, and at defined times during anaesthesia and surgery. Haemodynamic state was stable during induction and tracheal intubation in both groups, while during stressful operative periods there were increases in mean arterial pressure (17% in the fentanyl group; 11% in the sufentanil group), heart rate (fentanyl 20%, sufentanil 14%) and plasma concentrations of catecholamines (adrenaline: fentanyl 316%, sufentanil 86%; noradrenaline: fentanyl 78%, sufentanil 186%) in both groups. Sufentanil was similar to fentanyl in attenuating the haemodynamic and hormonal responses to surgical stimulation. In two patients in the fentanyl group and three in the sufentanil group, myocardial lactate production was observed temporarily, indicating myocardial ischaemia caused by surgical stress.
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PMID:Comparison of sufentanil-nitrous oxide anaesthesia with fentanyl-nitrous oxide anaesthesia in geriatric patients undergoing major abdominal surgery. 168 Mar 61

Seven different schemes for analgesic anaesthesia were investigated for their clinical applicability, potential side effects, and impacts on circulation parameters of the systemic and pulmonary (peripheral) circulation as well as on the intracranial pressure. In all, so patients per group were treated. The results revealed different reactions of patients, such as a higher incidence of disturbances of the autonomic nervous system and excitation after medication withdrawal. Favourable effects not only on clinical reactions but also on circulation parameters were seen during fentanyl/midazolam or alfentanil/midazolam therapy. In several instances, a clear increase in the right atrial and the pulmonary arterial mean pressure as well as the intracranial pressure was observed during ketamine/flunitrazepam therapy. The combinations pethidine/promethazine or pethidine/flunitrazepam also showed clear side effects on the circulation and evoked an increase in the intracranial pressure. Fentanyl/midazolam or alfentanil/midazolam treatments were the most favourable combinations for most of the patients who were artificially respirated.
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PMID:[Analgosedation of the ventilated intensive care patient]. 168 4

Opioids are known to affect the MAC of inhalational anesthetics. We have determined the interaction between fentanyl and desflurane, following a bolus injection of fentanyl at induction in 134 adult patients. Five groups of patients were studied. Four groups received desflurane or isoflurane in oxygen with either fentanyl 3 or 6 micrograms/kg and thiopental 2-5 mg/kg given as a bolus injection at the time of induction. An additional group received desflurane in oxygen alone. Groups were stratified by age. MAC determination, in response to the stimulus of skin incision, was made using the "up-down" method and logistic regression. The MAC desflurane in oxygen was 6.3% (5.3-7.6%, 95% confidence interval [CI]). Fentanyl 3 micrograms/kg produced a fentanyl plasma concentration of 0.78 +/- 0.53 ng/ml at skin incision and resulted in a MAC for desflurane of 2.6% (2.0-3.2%, 95% CI) %. Fentanyl 6 micrograms/kg produced a fentanyl plasma concentration of 1.72 +/- 0.76 ng/ml at skin incision and resulted in a MAC for desflurane of 2.1% (1.5-2.6%, 95% CI). To compare recovery times to eye-opening and response to commands, patients were grouped according to the plasma fentanyl concentrations at the time of awaking. Recovery was faster in patients who received desflurane than in those who received isoflurane. The authors conclude that the MAC of desflurane is significantly reduced 25 min following a single dose of 3 micrograms/kg of fentanyl and that increasing the fentanyl dose to 6 micrograms/kg produces little further decrease in MAC. Desflurane is also associated with faster recovery from anesthesia than is isoflurane.
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PMID:Reduction of the MAC of desflurane with fentanyl. 172 36

Fentanyl/diazepam anesthesia is an appropriate combination for surgical operations on the guinea pig, since it ensures definitive anesthesia and analgesia without respiratory depression. Comparative investigations with pentobarbital and urethane were carried out to check their applicability for electrocochleographic recordings. We found that fentanyl/diazepam combination anesthesia is more suitable for electrocochleographic investigations than pentobarbital. We were thereby able to prove that pentobarbital has an attenuating effect on electrocochleographic recordings in contrast to the findings reported in the available literature. For this reason, and because the lowest rates of animal morbidity occurred with fentanyl/diazepam, this combination anesthesia should be used preferentially for electrophysiological experiments in guinea pigs.
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PMID:The value of fentanyl/diazepam anesthesia for experimental operations and recordings of compound action potentials in the guinea pig cochlea. 174 48

One hundred and sixty-four patients scheduled for elective termination of pregnancy under general anaesthesia were randomly assigned to receive one of three different supplements to propofol and oxygen in nitrous oxide anaesthesia: 0.1 mg fentanyl, 0.5 mg alfentanil or placebo. Postoperative pain and nausea, as well as complications during anaesthesia were studied. There were no differences in complications or complaints by surgeons during anaesthesia, and no patient in any group reacted unsatisfactorily to surgery. The patients in the placebo group consumed significantly more propofol during the procedure (P less than 0.001). No differences were seen in time until hospital discharge between the three groups. Complaints about postoperative pain were significantly less frequent among patients receiving fentanyl (P less than 0.01). The number of patients requesting postoperative analgetics, however, did not differ. There was no difference in the frequency of nausea or vomiting, but postoperative pain was found significantly to increase complaints of nausea (P less than 0.01) and also time until hospital discharge (P less than 0.01). In conclusion, opioid supplementation lowered the amount of propofol needed for anaesthesia. Alfentanil 0.5 mg did not improve the postoperative course. Fentanyl 0.1 mg decreased the frequency of postoperative pain without increasing the time to hospital discharge.
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PMID:Opioid supplementation to propofol anaesthesia for outpatient abortion: a comparison between alfentanil, fentanyl and placebo. 176 99

The maternal and umbilical concentrations of fentanyl were measured after epidural analgesia for cesarean section, using a highly sensitive radioimmunoassay method. Sixteen parturients were anesthetized with a single epidural injection of a mixture of 85 mg bupivacaine 0.5%, 60 mg etidocaine 1%, and 100 micrograms fentanyl with epinephrine 1:200,000. Apparent maternal individual maximum peak concentration (Cmax) of fentanyl was 0.38 +/- 0.16 ng/ml (mean +/- SD) (range 0.12-0.59 ng/ml) and the time to reach Cmax (Tmax) was 24 +/- 14 min (range 5-60 min). Infants were born 19 to 42 min after epidural administration of fentanyl (mean 27 min). Fentanyl concentrations in neonates was 0.13 +/- 0.04 ng/ml for the umbilical vein and 0.06 +/- 0.03 ng/ml for the artery. The fetus extraction ratio was 53 +/- 19% (range 20-83%). The large difference between arterial and venous concentrations of fentanyl may be due to a metabolization by the fetus and/or an uptake of the drug in the fetal tissues. Thus, even if fentanyl levels reaching the fetus after cesarean section under epidural anesthesia, using local anesthetics with 100 micrograms of fentanyl, are within safe range values, the likelihood of fentanyl uptake by fetal tissues calls for a cautious use of repeated fentanyl administration.
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PMID:Maternal and umbilical cord concentrations of fentanyl after epidural analgesia for cesarean section. 176 14

Transdermal fentanyl 75 micrograms/h (Fentanyl-TTS) was compared with placebo in a randomized double-blind study in the early postoperative period, using 50 patients recovering from major urological operations. Analgesic efficacy was individually titrated with intravenous fentanyl by means of a PCA pump (demand dose 34 micrograms, lockout time 5 min). The test systems were applied 8 h before anaesthesia and were left in situ for 24 h. During the PCA period (18.2 h) patients with Fentanyl-TTS required significantly less additional fentanyl (0.48 vs 0.93 micrograms.kg-1.h-1) and reported less pain than patients in the placebo-group. Patient acceptance was high in both groups. Side-effects were of only minor intensity and did not differ between the two groups. In particular, there was no case of clinically relevant respiratory depression.
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PMID:Transdermal fentanyl for the treatment of pain after major urological operations. A randomized double-blind comparison with placebo using intravenous patient-controlled analgesia. 178 72

Analgesia and hemodynamic parameters during epidural anesthesia with trimecaine (2% solution) in combination with fentanyl (200 micrograms) have been studied in 56 patients aged 28-84 years. During premedication 34 patients were, in addition to atropine, dimedrol and relanium, administered galanthamine (15 mg); 22 patients were not given galanthamine. Fentanyl was administered with the first doses of the anesthetic. It has been established that premedication with galanthamine reduced the time of anesthesia onset by 19.6% and decreased the initial anesthetic dose by 10.7%. The initial period of anesthesia was characterized by a 23% increase in the number of cases with retained baseline BP level, a 1.6-fold decrease in the value of BP lowering, a 2.4-fold slowing of the time of hypotonic reaction development and a 31% shortening of the time of bradycardia onset.
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PMID:[The use of galanthamine in epidural anesthesia with trimecaine and fentanyl]. 178 88

Fentanyl, alfentanil, and sufentanil have important pharmacokinetic and pharmacodynamic differences. Selecting one of these opioid analgesics as an adjunct to general anesthesia requires appreciation of the relationship between the pharmacokinetic and pharmacodynamic characteristics of these drugs and the onset of and recovery from drug effect. Using a pharmacokinetic-pharmacodynamic model, the authors simulated the decrease in plasma fentanyl, alfentanil, and sufentanil concentration after intravenous administration by either bolus injection, brief infusion, or prolonged infusion. The percentage change in concentration, rather than absolute concentration, was simulated to permit comparison of the relative opioid concentration independently of drug potency. These computer simulations quantified the relationship between infusion duration and the time required for recovery after termination of the infusion. The analysis suggests that alfentanil is best used for operations longer than 6-8 h when a rapid decrease in effect site (i.e., biophase) opioid concentration is desired after discontinuation of the infusion. Alfentanil may also be the most appropriate drug to provide a transient peak effect after a single bolus. Although sufentanil has longer distribution and elimination half-lives than alfentanil, recovery from sufentanil infusions may be more rapid than recovery from alfentanil infusions for operations shorter than 6-8 h. These computer simulations demonstrate that simply comparing pharmacokinetic parameters (e.g., half-lives) of different drugs will not predict the relative rates of decrease in effect site concentrations after either an intravenous bolus or a continuous infusion.
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PMID:Pharmacokinetics, pharmacodynamics, and rational opioid selection. 182 43


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