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Objectives: Treating acute opioid withdrawal and offering medications for opioid use disorder (OUD) is critical. Hospitalization offers a unique opportunity to rapidly initiate methadone for OUD; however, little clinical guidance exists. This report describes our experience during the first 9 months following introduction of a hospital-based rapid methadone initiation protocol. Methods: We conducted a retrospective chart review of hospitalized patients with OUD seen by our interprofessional addiction medicine consult service at an urban academic center between December 2022 and August 2023.We identified patients who initiated methadone using the rapid methadone initiation protocol, which includes dose recommendations (maximum 60 mg day 1, 70 mg day 2, 80 mg day 3, 100 mg days 4–7) and strict inclusion and exclusion criteria (end organ failure, arrhythmia, concurrent benzodiazepine or alcohol use, age >65). Results: There were 171 patients that received methadone for OUD during the study period. Of those, 25 patients (15%) received rapid methadone initiation. The average total daily dose of methadone on days 1–7 was 53.0 mg, 69.2 mg, 75.4 mg, 79.5 mg, 87.1 mg, 92.2 mg, and 96.6 mg, respectively. There were no adverse events requiring holding a dose of scheduled methadone, naloxone administration, or transfer to higher level of care. Conclusions: A rapid methadone initiation protocol for OUD can be implemented in the inpatient setting. Patients up-titrated their methadone doses quicker than with traditional induction methods, and there were no serious adverse events. Appropriate patient selection may be important to avoid harms. [ABSTRACT FROM AUTHOR]

Background: In patients undergoing surgery, hemodynamic disorders are common. Therefore, we decided to compare the effects of fentanyl and dexmedetomidine on hemodynamic changes in patients undergoing Stereotactic surgery. Methods: In this double blinded clinical trial, 68 candidates for Stereotactic Surgery in Alzahra Hospital in 2017 enrolled in the study. Patients were randomly divided into two groups; the first group was given bolus of 2 μg / kg fentanyl, and in the second group a loading dose of 1 μgr / kg / 10 min, followed by maintenance dose of: 0.5 μg / kg / h of dexmedetomidine was admininstered intravenously. The Dexmedetomidine was infused immediately following anesthesia induction. The hemodynamic variables in the two groups were evaluated.Findings: There was no significant difference between the two groups based on systolic and diastolic blood pressure and oxygen saturation at different times. The heart rate in the dexmedetomidine group at 30, 60 and 90 minutes was significantly lower than fentanyl. On the other hand, there was no significant difference between the two groups with regards to pH, Pco2 and HCO3 before and after operation and recovery time.Conclusion: Both dexmedetomidine and fentanyl are two effective drugs for controlling hemodynamics parameters in patients undergoing stereotactic surgery, but dexmedetomidine drug reduces heart rate significantly compared with fentanyl.

Opioids are commonly required to relieve pain in critically ill patients, especially for those under mechanical ventilation (MV). Remifentanil, a potent u-opioid receptor with a rapid onset and offset, is widely used in anesthesia during surgeries, whereas less commonly administrated in the intensive care unit (ICU). This study is designed as a prospective, randomized, double-blind, controlled, parallel-group trial. Eligible 254 adult patients in ICU requiring MV for more than 24 h and ventilated for less than 48 h at the enrollment are randomly assigned to either the 'remifentanil group' or the 'fentanyl group', in which opioids will be infused for a maximum of 14 days. The primary outcome is the duration of MV. Secondary outcomes include the duration of extubation, costs and length of stay (LOS) in ICU, dose adjustment time, analgesic and sedative agent costs, short-term mortality, and adverse events potentially relevant to the study drugs. Data analysis will adopt an intention-to-treat approach. This trial will demonstrate the probability that remifentanil can reduce the duration of MV in long-term ventilated patients in critically ill patients compared to fentanyl. [ABSTRACT FROM AUTHOR]

What is known and Objective: Food and Drug Administration (FDA) risk evaluation and mitigation strategies (REMs) encourage emergency responders, paramedics, law enforcement agents, and even laypeople to be trained in the administration of naloxone with the intent of rescuing individuals from a known or suspected opioid overdose. Comment: Although naloxone is generally safe and effective at reversing respiratory depression caused by a conventional opioid such as morphine or heroin by competing with the opioid and displacing it from the μ‐opioid receptor, questions increasingly are arising as to whether naloxone can adequately reverse opioid overdoses that may involve the potent opioids fentanyl and its analogues (F/FAs). In other words, as more and more opioid overdoses involve F/FAs, can naloxone keep up? What is new and Conclusion: As a competitive antagonist at μ‐opioid receptors, naloxone is often a life‐saving agent in cases of overdose caused by conventional opioids, but it may not be versatile or powerful enough to combat the rising tide of overdoses due to fentanyl and its illicit analogues, or in cases of overdose involving combinations of opioids and non‐opioids. [ABSTRACT FROM AUTHOR]

Damage to spinal cord and its subsequent neurological deficits have been recognized as the complications of scoliosis repair surgery. Wake up test has been a safe, simple and reliable method to recognize such complications. Dexmedetomidine and Sevoflurane were the main anaesthetics for a 14 year old girl who underwent a scoliosis repair surgery with the intra operative wake-up test and hemodynamic stability. The analgesic property of Dexmedetomidine was complemented by the continuous Fentanyl infusion. Dexmedetomidine, Sevoflurane and continuous Fentanyl infusions were administered to achieve the maintenance of the anesthesia. These anaesthetic regimens produced a satisfactory result for the intra operative hemodynamic stability and the wake-up test with the minimum complication. Here, a case of scoliotic repair surgery was presented using Dexmetomidine, Sevoflurane and Fentanyl infusion as the safe anaesthetic regimens. [ABSTRACT FROM AUTHOR]

Background: one of the primary aims of anesthesia is to alleviate the patient's pain and agony, by permitting the performance of surgical procedures without any discomfort. Relief of postoperative pain has gained real importance in recent years considering the central, peripheral and immunological stress response to tissue injury. Any expertise acquired in this field should be extended into the postoperative period, which is the period of severe, intolerable pain requiring attention. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Aim of the Work: the purpose of this study was to assess the postoperative analgesic requirements and the spinally mediated analgesic effects of intrathecal nalbuphine as an adjunct to intrathecal bupivacaine after cesarean section in comparison to intrathecal bupivacaine plus fentanyl. Patients and Methods: eighty female patients came to Demerdash Hospital for cesarean delivery, they were randomly allocated into two equal groups (40 patients) group F and group N. Group F: Bupivacaine-Fentanyl: Patients received an intrathecal injection of 2 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (25 μg) fentanyl. Group N: Bupivacaine-Nalbuphine: Patients received an intrathecal injection of 2 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.8 mg) Nalbuphine. Results: the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia moderately prolonged the time of postoperative analgesia, while the duration of analgesia was more prolonged and the adverse effects were minimal with the group of nalbuphine, our result shows no significant difference, but shows significant difference in the More rapid onset of sensory block with Fentanyl than with Naluphine, more rapid Regression time to S1 dermatome with Fentanyl than with Naluphine, the duration of motor block is shorter with Fentanyl than with Naluphine, patients receive rescue analgesia 6 h postoperatively is fewer with Nalpuphine than Fentanyl. Conclusion: more rapid onset of motor block in fentanyl group than in nalbuphine group, more rapid onset of sensory block with Fentanyl than with Naluphine, more rapid regression time to S1 dermatome with Fentanyl than with Naluphine. [ABSTRACT FROM AUTHOR]

Background: The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation. Methods: Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A (n = 30) received intrathecal injection of ropivacaine 2 ml (0.75%) and Group B (n = 30) ropivacaine 1.8 ml (0.75%) with fentanyl 10 μg. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Student′s t test (for parametric data) and Mann-Whitney U test (for non-parametric data) were used for statistical analyses. Results: There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B (P = 0.001). Duration of motor block was longer in group B being 210.51 ± 61.25 min than in group A being 286.25 ± 55.65 min (P < 0.001). Conclusion: The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects.

Background: An increasing interest in intravenous anesthetic agent has resulted from the availability of more effective intravenous agents. Objectives: Comparison of intravenous Ketamine with combination of intravenous Propofol and Fentanyl in ASA Gr. 1 patients of middle age in minor surgical procedures, To compare the haemodynamic fluctuation of intravenous Ketamine with intravenous propofol – fentanyl combination in short surgical procedure and to compare recovery and side-effective in postoperative period of intravenous Ketamine with intravenous propofol- Fentanyl combination in short surgical procedures. Methodology: This observational study includes 20 patients of ASA Grade I of either sex, especially those who were coming for minor surgery. Patients divided in group A: Patients were preoxygenated with 100% oxygen. Induction was done with injection Ketamine 2 mg/kg intravenous. O2 was given throughout surgery and group B: Patients were preoxygenated with 100% oxygen. Induction was done with inj. Fentanyl citrate I mg/kg over 1 minute followed after 3 minute by propofol 2.5 mg/kg O2 was given throughout surgery. Results: Highest patients belong to 21-30 years age group. Female were higher in both the group that male. Most of (18) patients belongs to 51 to 40 kg group. Falling in blood pressure and pulse was more in Group B than Group A patients. Post-operative side effects more seen Group A than Group B patients. Conclusion: Inspite of more side effects and more change in hemodynamics parameters in Propofol-fentanyl group than Ketamine group, Both Ketamine and Propofol–fentanyl combinations produce rapid, pleasant and safe anesthesia with only a few untoward side effects and only minor hemodynamic effects.

Background: The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation. Methods: Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A (n = 30) received intrathecal injection of ropivacaine 2 ml (0.75%) and Group B (n = 30) ropivacaine 1.8 ml (0.75%) with fentanyl 10 μg. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Student's t test (for parametric data) and Mann-Whitney U test (for non-parametric data) were used for statistical analyses. Results: There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B (P = 0.001). Duration of motor block was longer in group B being 210.51 ± 61.25 min than in group A being 286.25 ± 55.65 min (P < 0.001). Conclusion: The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects. [ABSTRACT FROM AUTHOR]

In many animal species, as well as in humans, high doses of fentanyl (F) produce marked neurotoxic effects, such as muscular rigidity and respiratory depression. The antinociception (hot-plate test), impairment of motor coordination (rotarod test) and acute toxicity of intraperitoneal newly synthesized analogs, (±)cis-3 carbomethoxy- fentanyl (C) and (±)trans-3-carbomethoxyfentanyl (T) were evaluated in mice. The compounds tested induced antinociception, impairment of performance on the rotarod, and lethality in a dosedependent manner. The relative order of antinociceptive potency was similar to motor impairment potency, as well as lethality: F > C > T. Naloxone hydrochloride (1 mg/kg; sc) abolished all the effects observed, suggesting that they are mediated via opioid receptors,most probably of ì type. There were no significant differences between the therapeuticindices of F, C and T. It is concluded, the introduction of 3-carbomethoxy group in the piperidine ring of the fentanyl skeleton reduced the potency, but did not affect tolerability and safety of the compound. [ABSTRACT FROM AUTHOR]

Introduction. Epidemics related to illicit fentanyl abuse have been reported and the potential exists for a national epidemic associated with high mortality. This report describes emergency department visits for opioid toxicity and a recent outbreak of illicit fentanyl fatalities in Chicago, Illinois and surrounding Cook County. Methods. Retrospective chart review of opioid-related overdoses seen in our emergency department and a retrospective review of data from the Cook County Medical Examiner's Office Fentanyl Fatality Database from April 2005 through December 2006. Results. Our emergency department treated 43 patients with a total of 55 emergency department visits during this time. Paramedic transport was utilized for 83.6% of the emergency department visits and naloxone was administered during 80.4% of transports. Naloxone was administered during 47.3% of emergency department visits witwh total doses ranging from 0.4 mg to 12 mg. Eighty percent of cases were treated and discharged from the emergency department. During this same time frame, the Medical Examiner's office identified 342 fentanyl-related fatalities. In 2006, illicit fentanyl fatalities represented 6.9% of all Medical Examiner cases for that year. Approximately 80% of deaths occurred in Chicago. A peak in fentanyl-related deaths occurred in the spring of 2006 and again in the fall of 2006 while the number of emergency department visits peaked during May of 2006. Conclusion. Chicago and surrounding Cook County experienced an outbreak of 342 fentanyl-related deaths between April 2005 and December 2006. The experience demonstrated a clear need for an interdisciplinary approach to identifying, communicating, and managing an outbreak. [ABSTRACT FROM AUTHOR]