- |||||||||| fentanyl citrate / Generic mfg.
The Parturient with Surgically Corrected Scoliosis and a Non-reassuring Fetal Heart Rate (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_883;
You thread an epidural catheter 5 cm past the tip of the needle and use it to administer 15 ml of a solution of 0.08% bupivacaine + 2 mcg/mL fentanyl...Should you intubate? How do you manage her partner, who is seated next to her at the head of the OR table and appears frightened and bewildered as this scene unfolds?
- |||||||||| midazolam hydrochloride / Generic mfg.
Perioperative Management of the Lactating Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_864;
When you arrive in the operating room, the surgical fellow asks you for recommendations in anticipation of prescribing oral narcotic medication. How would you advise him?
- |||||||||| The Changing Face of Buprenorphine: To Stop or Not to Stop? (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_801;
Buprenorphine patch (Butrans®)?...Hydromorphone 1mg is bolused every 15 minutes with some decrease in blood pressure and heart rate...The fentanyl infusion is decided to be continued post-operatively for pain control as well as to prevent opioid withdrawal...Hypothetically, let's assume this patient was not on Suboxone® and instead received a naltrexone IM injection yesterday. 19) What are your concerns with a recent naltrexone injection versus after two weeks?20) What would be your concerns if this patient had a pre-existing subcutaneous naltrexone implant that was placed one month ago?
- |||||||||| ketamine / Generic mfg.
Lost in Conversion: Intrathecal Opioids to Equivalent Oral Opioids in a Chronic Pain Patient with an Intrathecal Drug Delivery System (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_749;
Currently, >300,000 IDDSs have been implanted for chronic cancer pain and non-cancer pain, such as discogenic pain, lumbar spinal stenosis, low back pain, chronic abdominal pain, complex regional pain syndrome, and neuropathic pain conditions.2 Only three drugs (morphine, baclofen, and ziconotide) are approved by the US Food and Drug Administration (FDA) for use in intrathecal pain pump, but several drugs are used off-label, such as hydromorphone, fentanyl, sufentanyl, ketamine, clonidine, and bupivacaine...CASE HISTORY The patient is a 66-year-old female with a past medical history significant for pulmonary embolism, deep venous thrombosis (on Xarelto), bipolar disorder, asthma, chronic obstructive pulmonary disease, and chronic low back pain...Her pain is well controlled with oxycontin 30 mg bid and oxycodone 15 mg tid...Does it relate to the content of drug or it can happen to anyone with intrathecal drug delivery? 10) Your new pain fellow asked if there is anything you can do to prevent formation of granuloma in other patients.
- |||||||||| ceftriaxone / Generic mfg.
What an Ethical Dilemma! Endoscopic Retrograde Cholangiopancreaticography (ERCP) on a 99-year-old? (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_649;
Her past medical history includes atrial fibrillation on coumadin, coronary artery disease treated with multiple stents, transient ischemic attack, hypertension, pheochromocytoma, and hypothyroidism...She is started on Vancomycin and resuscitated with 1.5 liters of lactated ringers...What are the advantages and disadvantages of propofol-dexmedetomidine combination, propofol-ketamine combination, midazolam-fentanyl-Ketamine combination or Propofol alone when used for monitored anesthesia care?...4. What are the causes of pulmonary embolus during ERCP?
- |||||||||| ketamine / Generic mfg.
Lost in Conversion: Intrathecal Opioids to Equivalent Oral Opioids in a Chronic Pain Patient with an Intrathecal Drug Delivery System (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_622;
Currently, >300,000 IDDSs have been implanted for chronic cancer pain and non-cancer pain, such as discogenic pain, lumbar spinal stenosis, low back pain, chronic abdominal pain, complex regional pain syndrome, and neuropathic pain conditions.2 Only three drugs (morphine, baclofen, and ziconotide) are approved by the US Food and Drug Administration (FDA) for use in intrathecal pain pump, but several drugs are used off-label, such as hydromorphone, fentanyl, sufentanyl, ketamine, clonidine, and bupivacaine...CASE HISTORY The patient is a 66-year-old female with a past medical history significant for pulmonary embolism, deep venous thrombosis (on Xarelto), bipolar disorder, asthma, chronic obstructive pulmonary disease, and chronic low back pain...Her pain is well controlled with oxycontin 30 mg bid and oxycodone 15 mg tid...Does it relate to the content of drug or it can happen to anyone with intrathecal drug delivery? 10) Your new pain fellow asked if there is anything you can do to prevent formation of granuloma in other patients.
- |||||||||| midazolam hydrochloride / Generic mfg.
Perioperative Management of the Lactating Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_566;
When you arrive in the operating room, the surgical fellow asks you for recommendations in anticipation of prescribing oral narcotic medication. How would you advise him?
- |||||||||| fentanyl citrate / Generic mfg., cefazolin / Generic mfg., azithromycin / Generic mfg.
Converting Labor Epidural Analgesia to Cesarean Delivery Anesthesia: A Case of a Good Epidural Gone Bad (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_476;
You elect to proceed with a combined spinal epidural for labor analgesia, and deposit a spinal dose of 2.5cc of bupivacaine 0.0625%-fentanyl 2 mcg/mL...You give prophylactic IV cefazolin and IV azithromycin...23. How would you follow up with this patient after PACU?
- |||||||||| fentanyl citrate / Generic mfg.
[VIRTUAL] The Effects Of Anesthetics On Cardioversion Success (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_429;
The addition of midazolam to the sedation regimen for cardioversion may require more than one attempt for successful conversion to normal sinus rhythm. A future prospective study with randomization and controlling for medication doses may help give additional insight
- |||||||||| ketamine / Generic mfg.
The Heartbreak of Severe Aortic Stenosis in Pregnancy (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_424;
If she received ketamine supplementation for her previous C-section do you think that any of the responsibility for her post-partum mental health problems can be laid at the feet of ketamine?...After LOR was achieved at a different intervertebral level this time with CSF return, PF morphine 100 ug and fentanyl 10 ug are administered intrathecally and the epidural catheter is threaded...What should you do now? If you choose to use an intrathecal catheter how should it be dosed for c-section anesthesia?
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., tranexamic acid oral / Generic mfg.
Obstetric Hemorrhage: Be Ready, Prepare and Recognize (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_412;
A CSE is placed (1.5cc, hyperbaric 0.75% bupivacaine + fentanyl 15 mcg + preservative free morphine 150 mcg) in the OR and the surgery started...The MTP is continued and you request cryoprecipitate and tranexamic acid...On postoperative day two the patient's trachea is extubated and she is transferred to the postpartum floor on postoperative day three. The patient and her neonate are discharged home on postoperative day five.
- |||||||||| midazolam hydrochloride / Generic mfg., lisinopril / Generic mfg.
It's Just A Cataract: How A Simple Thing Can Go Bad (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_322;
His medications include: lisinopril, 10 mg QD, atorvastatin, 20 mg QD, furosemide, 40 mg QD, ASA, 81 mg QD, tamsulosin, 0.4 mg QD, allopurinol, 100 mg QD, and ibuprofen, 800 mg as needed...He has not taken any of his medications, and was told to stop his aspirin 10 days prior to surgery...The patient is given midazolam, 1 mg IV and propofol, 50 mg IV...During this time, the patient begins to complain about back pain, and you administer fentanyl, 50 ug IV...How do you respond? If the patient presented for surgery at this time and stated he had been off of his ASA and clopidogrel for 10 days, how would you respond?
- |||||||||| Eladur (bupivacaine) / Amneal
[VIRTUAL] Intrathecal Bupivacaine Dosing For Transvaginal Cervical Cerclage: A Retrospective Analysis (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_305;
An inadequate block was defined as a failed block or a block requiring IV analgesic supplementation with ketamine, propofol, midazolam >2mg, fentanyl >50 mcg or epidural supplementation (if a CSE technique was used). Bupivacaine doses greater than 7.5 mg were associated with a lower risk of inadequate blocks for transvaginal cervical cerclage placement compared to a 7.5 mg dose, without prolonging the time to discharge.
- |||||||||| fentanyl citrate / Generic mfg., ropivacaine / Generic mfg.
[VIRTUAL] Comparison Of Neuraxial Techniques For Labor Analgesia: A Retrospective Analysis (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_301;
DPE was used more in those with higher BMI and CSE was more commonly used in multiparous patients with shorter duration of labor analgesia. Catheters placed by EPL technique needed more replacements than those placed by CSE and DPE techniques consistent with previous data indicating confirmation with successful dural puncture with CSE and DPE techniques may reduce catheter failure.
- |||||||||| Bridion (sugammadex) / Merck (MSD)
Surgeon Promises: Just a Five-Minute Case. Options for Airway and Neuromuscular Blockade Management in a Morbidly Obese Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_126;
He remained intubated and sedated on fentanyl and propofol infusions...The resident calls from the pharmacy to inform you that the hospital does not presently have sufficient sugammadex in stock...11.What common problems are associated with this method of induction?12.Would you give any premedication to minimize potential adverse effects? Which one(s)?13.What doses of remifentanil and propofol would you use?
- |||||||||| ketamine / Generic mfg.
Opioids and the Operating Room: Peri-operative Wean, Intra-operative Care, and Post-operative Pain Management (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_72;
Since she fell and fractured her ankle, she has been taking hydrocodone/acetaminophen 10/325 mg 6-8 times a day, prescribed by the emergency department...What if she were on chronic opioids such as morphine and hydrocodone, would a peri-operative wean be necessary?...You proceed with the surgery and take the patient to the operating room where you induce general anesthesia with propofol, fentanyl, and rocuronium uneventfully...The ketamine infusion is weaned and she is started on oral methadone 20mg three times daily with a fentanyl patient controlled analgesia (PCA) for break through pain...How will you discharge the patient from the hospital with treatment for the pain and addiction? Is it safe to prescribe a recovering opioid addict short-acting agents?
- |||||||||| The Age Old Dilemma: How Do We Fix a Broken Hip? (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_70;
The patient takes an 81 mg aspirin daily and is allergic to Penicillins...He is a retired engineer and, at one point, is noted to have been on coumadin...After an awake arterial line, you gently induce your patient with fentanyl, low dose propofol and rocuronium...What can we do to help this patient in the PACU? . . . Further discussion regarding postoperative delirium, postoperative cognitive decline, frailty, among other topics (if time allows.)
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg.
Review, Journal: GRKs as Key Modulators of Opioid Receptor Function. (Pubmed Central) - Jun 16, 2021
Numerous strategies, such as phosphosite specific antibodies and mass spectrometry have allowed the detection of phosphorylated residues and the use of mutant knock-in mice have shed light on the role of GRK regulation in opioid receptor physiology. Here we review our current understanding on the role of GRKs in the actions of opioid receptors, with a particular focus on the MOR, the target of most commonly used opioid analgesics such as morphine or fentanyl.
- |||||||||| ketamine / Generic mfg., amphetamine / Generic mfg.
Journal: The prevalence of alcohol and other drugs in fatal road crashes in Victoria, Australia. (Pubmed Central) - Jun 12, 2021
A decline in the prevalence of alcohol in fatalities suggests that law enforcement and public health strategies in Australia to address road fatalities and drink-driving may have had a positive effect. However, increases were observed in the incidence of other potentially impairing drugs including opioids and amphetamines, specifically methylamphetamine, indicating a concerning trend in road safety in Victoria that warrants further monitoring.
- |||||||||| Journal: Influence of peri-incisional epaxial muscle infiltration with bupivacaine pre- or post-surgery on opioid administration in dogs undergoing thoraco-lumbar hemilaminectomy. (Pubmed Central) - Jun 12, 2021
Response to surgery, defined as a change in autonomic physiological variables >20% above baseline, was treated with fentanyl 2.5 mcg/kg boluses, followed by a continuous rate infusion of fentanyl at 5 mcg/kg/h...Group A (median, 0; range, 0-3), had significantly fewer total analgesic interventions than Group B (median, 3; range, 0-6) and Group C (median, 4; range, 1-7; P = 0.014). Bupivacaine reduced peri-operative opioid administration and pre-surgical peri-incisional infiltration yielded the greatest benefit.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. (Pubmed Central) - Jun 12, 2021
A 'fourth wave' of high mortality involving methamphetamine and cocaine use has been gathering force in the USA. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: High-power short-duration radiofrequency ablation of typical atrial flutter. (Pubmed Central) - Jun 12, 2021
Patients in the HPSD group required 50 mcg less fentanyl relative to the standard ablation arm after adjusting for sex, age, and comorbidities (P = .048)...This strategy may reduce ablation time and analgesia requirements. Larger studies and longer follow-up are needed to further evaluate this strategy.
- |||||||||| ketorolac / Generic mfg.
Journal: Perioperative pain control and tympanostomy tube outcomes. (Pubmed Central) - Jun 11, 2021
The result of this analysis indicates that intraoperative dexmedetomidine administration could decrease the hemodynamic response and provide hemodynamic stability during skull-pin head-holder application in neurosurgery. Ketorolac is a reasonable non-narcotic alternative to fentanyl which provides equal pain control and does not increase tube occlusion rates.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Perspectives on Fentanyl Test Strip Use among People Who Inject Drugs in Rural Appalachia. (Pubmed Central) - Jun 10, 2021
Participants described how receiving a positive FTS result may lead them to engage in overdose risk reduction behaviors. Augmenting existing overdose prevention initiatives in rural Appalachia such that rural PWID have access to FTS may result in reductions in overdose fatalities.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Early Detection of Exposure to Toxic Chemicals Using Continuously Recorded Multi-Sensor Physiology. (Pubmed Central) - Jun 10, 2021
As a first step, we evaluated whether exposure to an opioid (fentanyl) or a nerve agent (VX) could be detected in freely moving guinea pigs using features from respiration, electrocardiography (ECG) and electroencephalography (EEG), where machine learning models were trained and tested on different sets (across subject classification)...Exposure detection models that were trained on subsets of animals generalized to subsets of animals that were exposed to other dosages of different chemicals. While future work is required to validate the principle in other species and to assess the robustness of the approach under different, realistic circumstances, our results indicate that utilizing different continuously measured physiological signals for early detection and identification of toxic agents is promising.
- |||||||||| fentanyl citrate / Generic mfg., paracetamol / Generic mfg., tramadol hydrochloride / Generic mfg.
Journal: Comparison of analgesic requirements in robot-assisted versus conventional laparoscopic abdominal surgeries. (Pubmed Central) - Jun 10, 2021
The time to ambulation was significantly shorter in group R patients (P < 0.001). Analgesic requirements were significantly less in robot-assisted laparoscopic surgery in the first 24 h. The time to ambulation and length of ICU stay were shorter in the robot-assisted group in comparison to the laparoscopic group.
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