- |||||||||| fentanyl citrate / Generic mfg.
Journal: Opioid Attack and the Implications for Counter-Terrorism Medicine. (Pubmed Central) - Nov 29, 2021
While the opioid epidemic engulfing the United States and the globe is well-documented, the potential use of powerful fentanyl derivatives as a weapon of terror is increasingly a concern...The combination of the potency of opioid derivatives along with the ease of accessibility poses a potential risk of the use of these deadly agents as chemical weapons, particularly by terrorist organizations. Disaster Medicine specialists in recent years have established a sub-specialty in Counter-Terrorism Medicine (CTM) to address and research the unique terrorism-related issues relating to mitigation, preparedness, and response measures to asymmetric, multi-modality terrorist attacks.
- |||||||||| fentanyl citrate / Generic mfg., methamphetamine / Generic mfg.
Clinical, Journal: Xylazine detected in unregulated opioids and drug administration equipment in Toronto, Canada: clinical and social implications. (Pubmed Central) - Nov 29, 2021
The increased risk of overdose associated with use of xylazine and its detection within our setting highlights the importance of drug checking services in supporting rapid responses to the emergence of potentially harmful adulterants. These data also highlight the clinical challenges presented by the dynamic nature of unregulated drug markets and the concomitant need to establish regulatory structures to reduce their contribution to overdose morbidity and mortality.
- |||||||||| midazolam hydrochloride / Generic mfg.
Journal: Factors Influencing CAM-ICU Documentation and Inappropriate "Unable to Assess" Responses. (Pubmed Central) - Nov 29, 2021
These data also highlight the clinical challenges presented by the dynamic nature of unregulated drug markets and the concomitant need to establish regulatory structures to reduce their contribution to overdose morbidity and mortality. Data from electronic health records can identify patient, clinical, and workplace factors associated with CAM-ICU documentation and inappropriate "unable to assess" responses, which can help target quality improvement efforts related to delirium assessment.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: High-Throughput Analysis from Complex Matrices: Acoustic Ejection Mass Spectrometry from Phase-Separated Fluid Samples. (Pubmed Central) - Nov 29, 2021
We demonstrate the quantitative determination of fentanyl from urine using this two-phase AEMS approach, with a LOD lower than 1 ng/mL, quantitation precision of 15%, and accuracy better than ±10% over the range of evaluation (1-100 ng/mL). This workflow offers simplified sample preparation and higher analytical throughput for some bioanalytical applications, in comparison to an LC-MS based approach.
- |||||||||| fentanyl citrate / Generic mfg., methamphetamine / Generic mfg.
Modeling Polysubstance Abuse With Drug-Drug Choice Procedures in Rats ([VIRTUAL]) - Nov 28, 2021 - Abstract #ACNP2021ACNP_1444;
The current studies suggest that when two drugs from the same class (i.e., MDPV and cocaine) are available, rats treat them as substitutes, choosing the functionally larger dose. However, when drugs from different pharmacological classes (i.e., methamphetamine and fentanyl) are available, some rats treat them as compliments, sampling both drugs throughout the session, whereas others display a preference for one drug or the other that is sensitive to dose manipulations as observed with MDPV and cocaine.
- |||||||||| remifentanil / Generic mfg.
Chronic Pain Selectively Alters the Motivation to Work for Remifentanil but Not Food Reward in Mice ([VIRTUAL]) - Nov 28, 2021 - Abstract #ACNP2021ACNP_1316;
This effect was specific to the opioid and did not impact their willingness to work for a non-drug food reward (Ensure). While it is currently unclear what causes this selective switch in SA responding between schedules in CCI mice for remifentanil, it is likely due to a changing balance between the analgesic properties and hedonic value of remifentanil.
- |||||||||| fentanyl citrate / Generic mfg.
Role of dynorphin/κ-Opioid Receptor on Fentanyl Vapor Self-Administration in Mice ([VIRTUAL]) - Nov 28, 2021 - Abstract #ACNP2021ACNP_1017;
The effect of chronic treatment with short-acting -opioid receptor antagonists on opioid self-administration remains to be tested. Deletion of the pro-dynorphin gene may have sex-dependent effects that merit further study.
- |||||||||| fentanyl citrate / Generic mfg.
Daily Methocinnamox Treatment Attenuates Fentanyl Self-Administration in Rhesus Monkeys ([VIRTUAL]) - Nov 28, 2021 - Abstract #ACNP2021ACNP_890;
MCAM attenuated fentanyl self-administration and dose-dependently shifted the fentanyl dose-effect curve rightward nearly 50 fold with the largest daily treatment dose of 0.1 mg/kg. These results, taken together with previous studies demonstrating long-lasting and selective attenuation of opioid self-administration, support the view that MCAM could be a safe and effective treatment for opioid use disorder.
- |||||||||| fentanyl citrate / Generic mfg.
Neuron Subtype Specific Molecular Mechanisms in Fentanyl Abstinence ([VIRTUAL]) - Nov 28, 2021 - Abstract #ACNP2021ACNP_782;
Our findings indicate that fentanyl abstinence causes unique structural, functional, and molecular changes in NAc D1-MSNs. Further, these molecular changes can be targeted to alleviate abstinence-induced dendritic atrophy and stress-like behaviors.
- |||||||||| fentanyl citrate / Generic mfg.
Role of dynorphin/κ-Opioid Receptor on Fentanyl Vapor Self-Administration in Mice (Exhibit Hall C) - Nov 28, 2021 - Abstract #ACNP2021ACNP_717;
The effect of chronic treatment with short-acting -opioid receptor antagonists on opioid self-administration remains to be tested. Deletion of the pro-dynorphin gene may have sex-dependent effects that merit further study.
- |||||||||| fentanyl citrate / Generic mfg.
Daily Methocinnamox Treatment Attenuates Fentanyl Self-Administration in Rhesus Monkeys (Exhibit Hall C) - Nov 28, 2021 - Abstract #ACNP2021ACNP_684;
MCAM attenuated fentanyl self-administration and dose-dependently shifted the fentanyl dose-effect curve rightward nearly 50 fold with the largest daily treatment dose of 0.1 mg/kg. These results, taken together with previous studies demonstrating long-lasting and selective attenuation of opioid self-administration, support the view that MCAM could be a safe and effective treatment for opioid use disorder.
- |||||||||| remifentanil / Generic mfg.
Chronic Pain Selectively Alters the Motivation to Work for Remifentanil but Not Food Reward in Mice (Exhibit Hall C) - Nov 28, 2021 - Abstract #ACNP2021ACNP_235;
This effect was specific to the opioid and did not impact their willingness to work for a non-drug food reward (Ensure). While it is currently unclear what causes this selective switch in SA responding between schedules in CCI mice for remifentanil, it is likely due to a changing balance between the analgesic properties and hedonic value of remifentanil.
- |||||||||| fentanyl citrate / Generic mfg.
Neuron Subtype Specific Molecular Mechanisms in Fentanyl Abstinence (Exhibit Hall C) - Nov 28, 2021 - Abstract #ACNP2021ACNP_115;
Our findings indicate that fentanyl abstinence causes unique structural, functional, and molecular changes in NAc D1-MSNs. Further, these molecular changes can be targeted to alleviate abstinence-induced dendritic atrophy and stress-like behaviors.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
RADIATION-INDUCED SARCOMAS RESPONDING TO PEMBROLIZUMAB ([VIRTUAL]) - Nov 26, 2021 - Abstract #CTOS2021CTOS_316;
There is excitement amongst the sarcoma community to pursue an actual trial utilizing immunotherapy for these radiation-induced sarcomas (irregardless of subtype). No matter, we are already seeing the positive responses and improvement in quality of life utilizing pembrolizumab in these situations, and would encourage trying pembrolizumab for any of the radiation-induced sarcomas you may encounter.
- |||||||||| fentanyl citrate / Generic mfg., rocuronium / Generic mfg.
Klippel Trenaunay Syndrome - when risk meets cardiac surgery ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1228;
KTS is not only associated with venous malformations which hold difficulties for venous cannulation (CBP and central venous access), but also with Kasabach Merritt Syndrome (thrombocytopenia and coagulopathy) and difficult airway due to frequent soft tissue hypertrophy.1,2 The hemorrhagic risk is severely compounded by CPB itself and its coagulopathic potential. We present a successful approach of a KTS case for cardiac surgery emphasizing the importance of perioperative planning and risk reduction.Learning points:Despite the risks and potential difficulties, cardiac anesthetic management of KTS patients can be done safely.
- |||||||||| midazolam hydrochloride / Generic mfg.
Mucopolysaccharidosis type IIIA - anesthesia approach, a case report ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1222;
The patient was sedated using 0,5 MAC of sevoflurane and 1 mcg/kg of fentanyl...After confirmation of a secure airway, induction of general anesthesia, guided by Bispectral index and neuromuscular blockade was performed using rocuronium...Preferably, a full diagnosis and comorbidities optimization should occur before an elective procedure. Early recognition of difficult airway allowing for timely planning and management is crucial for patient safety.Learning points: Difficult airway management has been reported so planning and preparation for all possible scenarios is important to assure the safety of our patients.
- |||||||||| fentanyl citrate / Generic mfg., sevoflurane / Generic mfg., rocuronium / Generic mfg.
Endotracheal tube obstruction during oesophageal atresia and tracheoesophageal fistula repair: a case Report ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1214;
OTT obstruction by a blood clot is an uncommon complication with reported incidence <2%.[2] Differential diagnoses include anaesthesia machine malfunction, extraluminal and other causes of OTT intraluminal obstruction, external lung compression and bronchospasm.[3] To our knowledge, there are no other reported cases of this kind of airway obstruction during TOF and OA repair surgery.Learning points: TOF/OA repair is a challenge for the Anesthesiologists. One should be aware of airway difficulties and ventilation critical incidents.
- |||||||||| ketorolac / Generic mfg., dexamethasone / Generic mfg.
Ehlers-Danlos Syndrome, what now? ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1170;
Currently, there are no guidelines for regional or general anesthesia in patients with EDS. Rare conditions such as EDS can present a clinical conundrum for the anesthetist, nevertheless knowledge of the basic implications of the condition can minimize patient morbidity and mortality without requiring in-depth knowledge of the disease.
- |||||||||| midazolam hydrochloride / Generic mfg., labetalol / Generic mfg.
Anaesthetic conserving device AnaConDa® used for hypertension control in critical care of burned Patient ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1164;
Initially, sedoanalgesia was maintained with propofol and fentanyl and changed to midazolam, dexmedetomidine and fentanyl because his hypertension...Adjuvant medication included perfusion of isosorbide dinitrate, remifentanil rather fentanyl and esmolol rather labetalol, were added progressively with relatively low efficacy...Its blood pressure-lowering effect is well known. Our case report reveals the potential of sevoflurane, through AnaConDa® device, as a sedative and hypotensive drug to treat resistant hypertension Learning points: AnaConDa device as a safety and simple form of inhalation sedation and effect of sevoflurane-induced hypotension.
- |||||||||| fentanyl citrate / Generic mfg., lignocaine / Generic mfg., methadone / Generic mfg.
Analgesia Nociception Index to verify an epidural block in a patient addicted to opioids. Case Report ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1148;
Case Report: A 42-year-old male, treated with methadone for addition to opioids...After the incision, a high hemodynamic response appeared without response to repeated doses of fentanyl, urapidil and epidural lignocaine boluses...ANI could predict hemodynamic reactivity, works better than hemodynamic variations to predict pain, can be useful to adjust opioid titration, to predict the origin of a hemodynamic event, and in the verification of peripheral regional blocks in patients undergoing general anesthesia.Learning points: ANI allows continuous pain measurement and can be useful in pain monitoring in complex patients with central or peripheral blocks, undergoing general anesthesia.-ANI can optimize and individualize analgesia, facilitating the use of closed loop systems. Postoperative subjetive pain shows a good correlation with the ANI value.-The ANI limitations are the pathologies and medications that interfere with the parasympathetic tone.
- |||||||||| fentanyl citrate / Generic mfg., sevoflurane / Generic mfg., paracetamol / Generic mfg.
Combination of Pectoral blocks type1 and type 2 as a part of a multimodal analgesia plan in obese women undergoing total mastectomy ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1114;
Patients in both groups had a inhaled low-flow anesthesia with sevoflurane combined with pre-emptive (i.v. paracetamol and dexketoprofen) and systemic analgesia with fentanyl...The combination of Pectoral blocks type 1 and type 2 has analgetic and opioid-sparing advantages in obese women undergoing total mastectomy and may become prerequisites for opioid-free anesthesia in this patient’s group.
- |||||||||| fentanyl citrate / Generic mfg., sevoflurane / Generic mfg., lidocaine topical / Generic mfg.
Anaesthetic management in Apert’s Syndrome ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1099;
C-MAC videolaryngoscopy showed partially closed vocal cords; lidocaine 30mg was administered topically, allowing for subsequent insertion of 6mm endotracheal tube...Regional anesthesia is recommended. General anesthesia is an option when difficult airway management equipment is available.
- |||||||||| midazolam hydrochloride / Generic mfg.
Ductus arteriosus ligation in a 465g ultra-premature - how small is too small? ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1098;
Since lack of evidence precludes defining the best technique, homeostasis maintenance is the mainstay of practice. Knowledge of prematurity pathophysiology, which we briefly illustrate, is key for success.
- |||||||||| dexamethasone / Generic mfg.
Anesthetic management of foramen magnum meningiomas (FMM) – a comparison of 2 case reports - the ventral decubitus (VDP) vs the sitting position (SP) ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1076;
Before induction, dexamethasone, mannitol and 20% saline were administered...Propofol and fentanyl were used for induction...Saline 20%, mannitol and awake intubation was the best option for patient 1 due to tumor size, origin and severe compression of brainstem.Learning points:Posterior fossa surgery may require several different positions whose complications should be known, prevented and promptly treated. Tumor size and brainstem compression obligates an additional care during airway management.
- |||||||||| ketamine / Generic mfg.
Hybrid cardiac surgery in a 96-year-old patient: a case report ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1044;
Anesthetic induction with fentanyl 50mcg, propofol 40mg and rocuronium 50mg and maintenance with total intravenous anesthesia...The patient was transferred to the intensive care unit (ICU) intubated, at RASS 0, comfortable, without pain complaints and hemodynamically stable with norepinephrine 0.15mcg/kg/min and dobutamine 3mcg/kg/min...The most used model today is the EuroSCORE II, created from an international and highly accurate database. However, it has limitations such as the small number of patients over 90 years old in the sample (only 21), the oldest being 95 years old.1 Therefore, further studies should be conducted in this growing specific population in order to have a more reliable risk assessment.Learning points: Risk stratification models should include the elderly on their database.
- |||||||||| midazolam hydrochloride / Generic mfg.
Propofol Infusion Syndrome or Not? A case report ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1034;
He was treated with propofol (maximum of 2mg/Kg/h), fentanyl, rocuronium, invasive mechanical ventilation, noradrenaline (NA), continuous venovenous hemofiltration (CVVHF) and amoxicillin/clavulanic acid, with resolution of the bacterial coinfection and initial septic shock...Since rapidly escalating NA requirements were observed, a switch from propofol to midazolam was made...Learning points: PRIS is a rare entity but physicians who use propofol for sedation should be aware of its existence and its clinical features. Positive outcomes depend on early recognition, suspension of the infusion and adequate supportive care.
- |||||||||| Bridion (sugammadex) / Merck (MSD)
Laparoscopic cholecystectomy in patient with WolffParkinson White syndrome: don’t wake the beast! - A case report ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1029;
A rapid sequence induction was performed, with fentanyl, propofol and suxametonium...Therefore rocuronium is a good choice, for its cardiostability and reversal with sugammadex...Extubation after a lidocaine bolus safeguards both stimulation of the airway and conduction through the AV node, since it blocks sodium channels. Learning points: WPW patients can be safely managed with judicious choice of drugs, reducing the risk of degeneration into arrhytmias.
- |||||||||| fentanyl citrate / Generic mfg., haloperidol / Generic mfg.
Damage control in the frail orthopedic elderly pacient: case report ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_1000;
4mg Bupivacaina 0.1% + 10mcg fentanyl were given through the catheter...Minimum dose iv of etomidate and haloperidol for sedation and to tolerate the puncture...However, general anesthesia also poses a high risk due to vasodilation.The true contraindication is not to the technique itself but its hemodynamic effects.Learning points:Regional anaesthesia is the least invasive option in patients with high anesthetic risk. In this case of severe AS in a pluripathological elderly patient, CSA is a valuable option that allows us to adjust the dose of local anesthetics necessary, minimizing the hemodynamic risk and offering the rest of the advantages of a regional technique compared to general anaesthesia.
- |||||||||| Anesthetic management of pulmonary transplantation due to COVID-19 irreversible lung Injury ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_996;
General balanced anesthesia was used, induction made with propofol, fentanyl and cisatracurium; maintenance with sevoflurane, propofol, dexmedetomidine, remifentanil and cisatracurium for 14 hours...Hemorrhagic risk reduced with the use of tranexamic acid...Hemodynamic was optimized using balanced solution, albumin and vasopressors (norepinephrine, vasopressin and milrinone)...With proper precautions, Epidural PCA can be an effective and safe option in the pain management. Learning points: Lung transplantation may be a viable therapy at COVID-19 with irreversible pulmonary injury
- |||||||||| ketamine / Generic mfg.
The impact of low-opioid anaesthesia on postoperative pain after laparoscopic cholecystectomy ([VIRTUAL]) - Nov 25, 2021 - Abstract #Euroanaesthesia2021Euroanaesthesia_986;
The study group - 39 patients were anaesthetized with general anaesthesia with the low-opioid protocol (single intravenous dose of 0.1 mg fentanyl, only during the induction phase of anaesthesia, with co-analgesics: ketamine, lidocaine and magnesium sulfate), while 37 patients were control group (general anaesthesia using fentanyl as a main analgesic). The application of the proposed low-opioid anaesthesia protocol was safe and resulted in a reduction in the intensity of postoperative pain within 24 hours after laparoscopic cholecystectomy.
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