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Tonje A Sande, Barry J A Laird, Marie T Fallon
PURPOSE: Opioids are recommended for moderate to severe cancer pain; however, in patients with cancer, impaired renal function can affect opioid metabolism. The aim of this systematic review was to evaluate the current evidence for the use of opioids in cancer patients with renal impairment. METHODS: A systematic review was conducted and the following databases were searched: MEDLINE (1966 to 2015), EMBASE (1980 2015) and Cochrane Central Register of Controlled Trials (up to 2015)...
October 15, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Young Suk Kwon, Ji Su Jang, Na Rea Lee, Seong Su Kim, Young Ki Kim, Byeong Mun Hwang, Seong Sik Kang, Hee Jeong Son, So Young Lim
Background. Oxycodone, a semisynthetic opioid, has been widely used for acute and chronic pain. Objectives. The aim of this study was to compare the analgesic and adverse effects of oxycodone and alfentanil on postoperative pain after laparoscopic cholecystectomy. Methods. 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...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
Mathieu Fontaine, Jacques Latarjet, Jacqueline Payre, Jean-Charles Poupelin, François Ravat
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...
September 6, 2016: Burns: Journal of the International Society for Burn Injuries
Yi Hwa Choi, Kyung Mi Kim, Soo Kyung Lee, Yi Seul Kim, Seon Ju Kim, Woon Suk Hwang, Jin Huan Chung
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...
2016: BMC Anesthesiology
A Ke, Z Barter, K Rowland-Yeo, L Almond
In this study, we present efavirenz physiologically based pharmacokinetic (PBPK) model development as an example of our best practice approach that uses a stepwise approach to verify the different components of the model. First, a PBPK model for efavirenz incorporating in vitro and clinical pharmacokinetic (PK) data was developed to predict exposure following multiple dosing (600 mg q.d.). Alfentanil i.v. and p.o. drug-drug interaction (DDI) studies were utilized to evaluate and refine the CYP3A4 induction component in the liver and gut...
July 2016: CPT: Pharmacometrics & Systems Pharmacology
Ayten Saraçoğlu, Zeynep Eti, Deniz Konya, Kadir Kabahasanoğlu, Fevzi Yılmaz Göğüş
OBJECTIVE: We aimed to evaluate the depth of anaesthesia, perioperative haemodynamics, postoperative pain scores, analgesic consumption in patients receiving remifentanil- or alfentanil-based total intravenous anaesthesia for single-level lumbar discectomy. METHODS: Seventy patients undergoing discectomy were enrolled in the study. Patients were intravenously administered an initial bolus dose of 2 mg kg(-1) propofol and 10 mcg kg(-1) alfentanil or 1 mcg kg(-1) remifentanil, followed by 6 mg kg(-1) h(-1) propofol and either 1 mcg kg(-1) min(-1) alfentanil or 0...
February 2016: Turkish Journal of Anaesthesiology and Reanimation
Shanshan Cao, Yuwen Li, Lu Wang, Jia Cui, Na Jia, Ruili Li, Chao Zhao, Chao Wang, Yin Wu, Aidong Wen
OBJECTIVE: The study aims to investigate the possible mechanism of the synergistic analgesic effect of propofol-alfentanil combination. METHODS: The synergistic analgesic effects of propofol-alfentanil combination in Sprague-Dawley (SD) rats were analysed through the von Frey test. Then, we examined the activity of phospholipase C (PLC) and the intracellular levels of Ca(2+) and adenosine 3', 5'cyclic monophosphate (cAMP) in primary neuronal cells of fetal SD rats...
September 2016: Journal of Pharmacy and Pharmacology
Jing-Yang Liou, Chien-Kun Ting, Ming-Chih Hou, Mei-Yung Tsou
Classical midazolam-opioid combination for gastrointestinal endoscopy sedation has been adopted for decades. Dosing regimens have been studied but most require fixed dosing intervals. We intend to use a sophisticated pharmacodynamic tool, response surface model (RSM), to simulate sedation using different regimens. RSM can predict patient's response during different phases of the examination and predict patient's wake-up time with precision and without the need for fixed dosing intervals. We believe it will aid physicians in guiding their dosing strategy and timing...
June 2016: Medicine (Baltimore)
Hermanus Vaessen, Elisabeth Bruens, Johannes Knape
BACKGROUND AND STUDY AIM: The purpose of this study was to evaluate whether moderate-to-deep sedation with propofol and alfentanil can be administered safely by nonmedical sedation practitioners, and the outcomes of this practice in the Netherlands. We retrospectively analyzed the occurrence of sedation-related complications in patients undergoing gastrointestinal endoscopic procedures. PATIENTS AND METHODS: In this study, 597 adult patients consecutively underwent upper gastrointestinal endoscopic procedures...
May 2016: Endoscopy International Open
Jing-Yang Liou, Chien-Kun Ting, M Susan Mandell, Kuang-Yi Chang, Wei-Nung Teng, Yu-Yin Huang, Mei-Yung Tsou
BACKGROUND: Selecting an effective dose of sedative drugs in combined upper and lower gastrointestinal endoscopy is complicated by varying degrees of pain stimulation. We tested the ability of 5 response surface models to predict depth of sedation after administration of midazolam and alfentanil in this complex model. The procedure was divided into 3 phases: esophagogastroduodenoscopy (EGD), colonoscopy, and the time interval between the 2 (intersession). METHODS: The depth of sedation in 33 adult patients was monitored by Observer Assessment of Alertness/Scores...
August 2016: Anesthesia and Analgesia
Esmail Moshiri, Hesameddin Modir, Niknam Bagheri, Abolfazl Mohammadbeigi, Hamidreza Jamilian, Babak Eshrati
INTRODUCTION: Electroconvulsive therapy (ECT) is an effective treatment for many mental disorders, especially severe and persistent depression, bipolar disorder, and schizophrenia. The aim of this study is to compare the effect of dexmedetomidine and alfentanil on agitation, satisfaction, seizure duration, and patients hemodynamic after ECT. MATERIALS AND METHODS: In a three phase crossover randomized clinical trial, 75 patients aged between 18 and 50 years and candidate for ECT were enrolled and assigned into three groups (25 patients in each group)...
April 2016: Annals of Cardiac Anaesthesia
G Ozkan, M E Ince, M B Eskin, G Erol, M Kadan, G Ozgur, S Doganci, V Yildirim
OBJECTIVE: Electrical cardioversion (EC) is a short but painful procedure to restore sinus rhythm. The aim of this study is to compare the effect of fentanyl, remifentanil and alfentanil in association with propofol and midazolam for elective EC. PATIENTS AND METHODS: Ninety-nine patients older than 18-years, American Society of Anesthesiologists I/II/III grades undergoing elective EC were randomized into 3 groups. All patients received 2 mg midazolam and propofol (0...
2016: European Review for Medical and Pharmacological Sciences
F Montefiori, P Pawson, A Auckburally, M Scott, D Flaherty
OBJECTIVES: To evaluate sedation quality and cardiorespiratory variables in dogs sedated using a target-controlled infusion of propofol or propofol-alfentanil admixture. METHODS: A total of 60 dogs undergoing diagnostic imaging were randomly assigned to one of three sedation protocols: propofol alone; propofol with a low concentration of 12 µg of alfentanil per mL of propofol; or propofol with a higher concentration of 24 µg of alfentanil per mL of propofol. Target-controlled infusion was initiated at a propofol target concentration of 1·5 µg/mL and increased until lateral recumbency was achieved...
April 2016: Journal of Small Animal Practice
Susanne Eberl, Benedikt Preckel, Jacques J Bergman, Susan van Dieren, Markus W Hollmann
BACKGROUND: Dexmedetomidine possesses anxiolytic and hypnotic properties without respiratory side-effects, making it theoretically an ideal sedative agent for endoscopic procedures. OBJECTIVE: We aimed to compare satisfaction and safety among outpatients receiving sedation with dexmedetomidine or propofol for endoscopic oesophageal procedures. DESIGN: A randomised controlled study. SETTING: Endoscopic intervention suite at the Academic Medical Centre in Amsterdam, Netherlands...
September 2016: European Journal of Anaesthesiology
Nicolas Hohmann, Walter E Haefeli, Gerd Mikus
INTRODUCTION: Co-medication, gene polymorphisms and co-morbidity are main causes for high variability in expression and function of the CYP3A isoenzymes. Pharmacokinetic variability is a major source of interindividual variability of drug effect and response of CYP3A substrates. While CYP3A genotyping is of limited use, direct testing of enzyme function ('phenotyping') may be more promising to achieve individualized dosing of CYP3A substrates. AREAS COVERED: We will discuss available phenotyping strategies for CYP3A isoenzymes and causes of intra- and interindividual variability of CYP3A...
May 2016: Expert Opinion on Drug Metabolism & Toxicology
D F Johnston, M Stafford, M McKinney, R Deyermond, K Dane
BACKGROUND AND OBJECTIVES: Over the last 6 years, our center has introduced a novel technique combining peripheral nerve blocks (femoral and lateral femoral cutaneous nerves) with sedation using propofol with alfentanil target-controlled infusion for hip fracture surgery. The purpose of this review was to identify if adverse outcomes (of mortality and length of stay) were associated with its introduction compared to spinal or general anesthesia. METHODS: Retrospective data collection from hospital fracture database...
March 2016: Journal of Clinical Anesthesia
Hemanshu Prabhakar, Gyaninder Pal Singh, Zulfiqar Ali, Mani Kalaivani, Martha A Smith
BACKGROUND: Rocuronium bromide is a routinely used muscle relaxant in anaesthetic practice. Its use, however, is associated with intense pain on injection. While it is well established that rocuronium bromide injection causes pain in awake patients, anaesthetized patients also tend to show withdrawal movements of the limbs when this muscle relaxant is administered. Various strategies, both pharmacological and non-pharmacological, have been studied to reduce the incidence and severity of pain on rocuronium bromide injection...
2016: Cochrane Database of Systematic Reviews
Craig D'Cunha, Christos Plakiotis, Daniel W O'Connor
Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al...
June 2016: International Psychogeriatrics
Jing-Yang Liou, Chien-Kun Ting, Yu-Ying Huang, Mei-Yung Tsou
BACKGROUND: A response surface model is a mathematical model used to predict multiple-drug pharmacodynamic interactions. With the use of a previously published volunteer model, we tested the accuracy of the midazolam-alfentanil response surface model during gastrointestinal endoscopy. METHODS: We enrolled 35 adult patients scheduled for combined endoscopic procedures. Patients were sedated with intravenous midazolam and alfentanil, and monitored with real-time auditory evoked potential...
March 2016: Journal of the Chinese Medical Association: JCMA
Yuan Tan, Yisa Shi, Hui Ding, Xiangbin Kong, Haijiao Zhou, Jinhui Tian
BACKGROUND: Emergence agitation (EA) is an adverse effect after sevoflurane anesthesia in pediatric patients. The effectiveness of prophylactic μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil in preventing EA is debatable. METHODS: A literature search was conducted to identify clinical trials that observed the effect of μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil on preventing EA in pediatric patients under sevoflurane anesthesia...
February 2016: Paediatric Anaesthesia
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