- |||||||||| sevoflurane / Generic mfg.
Clinical, Journal: Spectral and Entropic Features Are Altered by Age in the Electroencephalogram in Patients under Sevoflurane Anesthesia. (Pubmed Central) - Jul 16, 2020
Regardless, most current EEG technology used to guide anesthetic management focus on spectral features, and improvements to these devices might involve integration of entropic features of the raw EEG. : WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Age-related changes in the electroencephalograms of anesthetized surgical patients have been explored but not fully characterized WHAT THIS ARTICLE TELLS US THAT IS NEW: Older age is associated with a shift to a less predictable electroencephalogram, which could influence intraoperative monitoring approaches.
- |||||||||| fentanyl citrate / Generic mfg.
Preclinical, Journal: Calabadion 1 selectively reverses respiratory and central nervous system effects of fentanyl in a rat model. (Pubmed Central) - Jul 16, 2020
: WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Age-related changes in the electroencephalograms of anesthetized surgical patients have been explored but not fully characterized WHAT THIS ARTICLE TELLS US THAT IS NEW: Older age is associated with a shift to a less predictable electroencephalogram, which could influence intraoperative monitoring approaches. Calabadion 1 selectively and dose dependently reversed the respiratory system and CNS side-effects of fentanyl.
- |||||||||| fentanyl citrate / Generic mfg., nebulized fentanyl citrate / Boehringer Ingelheim
[VIRTUAL] Exertional dyspnea in COPD: the dominant role of increased diaphragmatic activation (Channel 4) - Jul 15, 2020 - Abstract #ERS2020ERS_4509;
This double-blind crossover study compared combined supplemental O2 (FiO2=0.6) and nebulized fentanyl (100mcg) with nebulized bronchodilator (0.5mg ipratropium bromide+2.5mg salbutamol). The strong relationship between dyspnea intensity and diaphragm activation during exercise in COPD was not altered by selective therapeutic manipulation of central medullary or cortical motor centers which introduced significant differences in ventilation, and resting and dynamic respiratory mechanics.
- |||||||||| fentanyl citrate / Generic mfg.
[VIRTUAL] Variability of sedation controlled by pulmonologists during EBUS in Spain (Pre-congress content) - Jul 15, 2020 - Abstract #ERS2020ERS_1213;
Propofol (P) was the main drug (82.4%, Centres A&B: 416, 40-1050 mg), while Midazolam (M) (18.6%, Centre C: 4.1, 3-7 mg) was associated to Fentanyl (F) in 17/18 (0.1 mg)...Although procedures under P took longer (p 0.039), no significant difference in complications was found between MoS (P vs M+F and Nurse vs Assistant). Conclusion In a group of patients with high prevalence of comorbidities despite using different MoS, we found similar complication rates.
- |||||||||| fentanyl citrate / Generic mfg.
Preclinical, Journal: Sex differences in opioid reinforcement under a fentanyl vs. foodchoice procedure in rats. (Pubmed Central) - Jul 11, 2020
However, under a fentanyl vs. foodchoice procedure, males chose 3.2 µg/kg per injection fentanyl injections over 18%, but not 56%, diluted Ensure at a higher percentage compared to females. Overall, these results suggest that the expression of sex differences in opioid reinforcement depends upon the schedule of reinforcement and that preclinical opioid vs. food choice procedures provide a translationally relevant measure (i.e., behavioral allocation) consistent with the direction of sex differences reported in the clinical literature.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Computer-based Multitaper Spectrogram Program for Electroencephalographic Data. (Pubmed Central) - Jul 11, 2020
The EEGs of C57BL/6J mice were wirelessly recorded for 4 h after intraperitoneal injection of saline (vehicle control) and antinociceptive doses of morphine, buprenorphine, and fentanyl...The spectrograms unmasked differential opiate effects on EEG frequency and power. These computer-based methods are generalizable across drug classes and can be readily modified to quantify and display a wide range of rhythmic biological signals.
- |||||||||| fentanyl citrate / Generic mfg.
Clinical, Journal: Characteristics, symptom management and outcomes of 101 patients with COVID-19 referred for hospital palliative care. (Pubmed Central) - Jul 10, 2020
Frequently used medicines (median [range] dose/24 hours) were opioids (morphine, 10 [5-30] mg; fentanyl, 100 [100-200] mcg; alfentanil, 500 [150-1000] mcg) and midazolam (10 [5-20] mg)...Availability of subcutaneous infusion pumps is essential. An international minimum dataset for palliative care would accelerate finding answers to new questions as the COVID-19 pandemic develops.
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Clinical, Journal: Urban, individuals of color are impacted by fentanyl-contaminated heroin. (Pubmed Central) - Jul 9, 2020
Removal of trusted drug sources from a community may inadvertently increase overdose risk. Ensuring access to harm reduction resources (naloxone, drug testing strips) will remain important for addressing ever-increasing rates of overdose among all populations affected.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Novel Withdrawal Symptoms of a Neonate Prenatally Exposed to a Fentanyl Analog. (Pubmed Central) - Jul 7, 2020
The parents denied consent to treat with gabapentin, the suggested management for these symptoms; thus, a treatment protocol for methadone and clonidine were followed. This case exemplifies the medical and social complexities involved in treating polysubstance exposure-associated NAS.
- |||||||||| fentanyl citrate / Generic mfg.
[VIRTUAL] Feasibility of Using a Pharmacogenetic Assay in Mechanically Ventilated Adults (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_6997;
We targeted adult patients who had initiation of mechanical ventilation in the previous 72 hours and who had received >1 dose of fentanyl 25 mcg IV or morphine 2 mg IV or continuous infusion in the prior 24 hours...This was our only observed adverse event. Conclusion Although the sample size of our current study is too small to conduct inferential analyses, our demonstration of feasibility paves the way for a large study utilizing pharmacogenomics to determine the effects of genetic variability on response to analgesosedation in the ICU.
- |||||||||| fentanyl citrate / Generic mfg., vancomycin / Generic mfg., azithromycin / Generic mfg.
[VIRTUAL] An Unexplained Non-Convulsive Status Epilepticus: Always Do a Medication Review (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_6870;
He was sedated with continuous infusion of propofol and intermittent doses of fentanyl with daily sedation holiday where he would wake up and respond to verbal commands...Once diagnosis is reached, treatment is easily done by discontinuation of cefepime although some patients may require hemodialysis. Benzodiazepines and other anticonvulsants could be used for active seizures until the medication is cleared out of the body.
- |||||||||| fentanyl citrate / Generic mfg., vancomycin / Generic mfg.
[VIRTUAL] A Rare Cause for a Broken Heart: Right-Sided Invasive Infectious Endocarditis (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_6796;
A 34-year-old female with a history of intravenous fentanyl abuse presented to emergency department (ED) with fevers, generalized malaise, nausea, vomiting, abdominal pain, and back pain with high grade gram-positive cocci bacteremia...She was continued on Vancomycin due to persistent methicillin-resistant staphylococcus aureus bacteremia and required pressor support for developing septic shock...She was continued on antibiotics for 6 weeks after the surgery and was eventually discharged home but was unfortunately readmitted one year later with relapse of disease from recurrent intravenous drug use. The rarity of invasive right sided endocarditis has been thought to be due to the pressures exerted by the heart 2 , but this case shows that invasive disease can be apparent in the setting of intravenous abuse.
- |||||||||| Duragesic (fentanyl) / J&J
[VIRTUAL] Aaaah-choo! It's the Flu...and an Arterial Thrombosis Too (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_6782;
Due to difficulty with oxygenation on maximum ventilator settings, a neuromuscular blocker (NMB) was started in addition sedation with Propofol and Fentanyl...Pathogenesis of arterial thromboses is thought to be associated with increased release of pro-inflammatory mediators, inflammation induced endothelial damage and platelet activation. Due to the high morbidity of arterial thromboses, it is important to be aware of this entity to ensure prompt diagnosis and appropriate therapy when available.
- |||||||||| Flagyl (metronidazole) / SLA
[VIRTUAL] An Old Foe Returns: Fulminant Generalized Tetanus in a Community Setting (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_6767;
A diagnosis of generalized tetanus was made, prompting the administration of human tetanus immunoglobulin, tetanus toxoid, and metronidazole...Given her history of polysubstance abuse and high tolerance to sedatives, she required high dose propofol, fentanyl, and midazolam infusions...Tetanus is a rare but severe illness that most practitioners in the USA are not familiar with, but is something healthcare providers should be vigilant for, given the prevalent era of vaccine skepticism. Treatment involves neutralization of the offending toxin with immunoglobulin, and antibiotics.
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[VIRTUAL] Impact of Group III/IV Afferent Feedback on Breathing Pattern During Incremental Cycling Exercise to Peak Capacity in Patients with COPD (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_5901;
These tests were separated at least by 7 days, and were performed after either active (intrathecal administration of 25 μg fentanyl) or sham (NaCl) spinal anesthesia, in a cross-over, randomized, and double-blind fashion... Spinal anesthesia exerted only a modest influence on breathing pattern during incremental cycling exercise tests in patients with COPD suggesting that group III/IV afferent signalization of the lower limbs is not a major regulator of exercise performance during this form of exercise in patients with COPD.
- |||||||||| fentanyl citrate / Generic mfg., Decadron (dexamethasone) / Merck (MSD), Bridion (sugammadex) / Merck (MSD)
[VIRTUAL] A Rare Case of Acquired Pseudocholinesterase Deficiency (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_5559;
The following medications were administered in the OR: fentanyl 150mcg, propofol 220mg, midazolam 2mg, decadron, toradol, rocuronium 70mg and succinylcholine 150mg...Reversal agents sugammadex 600mg, glycopyrrolate, ephedrine 100mg and neostigmine were administered...This case demonstrates the importance to identify patients at risk and recognize the signs and symptoms of this deficiency in order to prevent complications including prolonged mechanical ventilation. The infrequency of encountering this deficiency made it a unique presentation.
- |||||||||| fentanyl citrate / Generic mfg.
[VIRTUAL] Fentanyl Induced Chest Wall Rigidity (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_5319;
Lipophilic opioids such as fentanyl, remifentanil and sufentanil are implicated...We believe that in our patient, fentanyl induced rigidity was initially masked by vecuronium...It is, therefore, important to consider this rare side effect of opioids as a cause of inadequate ventilation. Future use of fentanyl or other opioids is not contraindicated as per current guidelines.
- |||||||||| ketamine / Generic mfg.
[VIRTUAL] Ketamine Infusion for ICU Sedation and Analgesia: A Multicenter Evaluation (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_4449;
Other sedative or opioid infusions were administered with ketamine in 76% (propofol most frequently) and 92% (fentanyl most frequently) of cases, respectively. Ketamine infusion was most frequently used as an adjunct to more standard sedative and opioid infusions in this ICU population, with noticeable but unintended effects attributed to ketamine in nearly one-quarter of cases.
- |||||||||| fentanyl citrate / Generic mfg.
[VIRTUAL] Pulsus Bisferiens Without Aortic Valve Disease (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_4329;
Urine toxicology was positive for fentanyl, cocaine and alcohol...Despite supportive management, the patient succumbed to multi-system organ failure. Knowledge of arterial waveforms is important in managing critically ill patients and provides rapid insight to underlying cardiovascular pathophysiology.
- |||||||||| [VIRTUAL] Palliative Care Utilization Among Veterans with Advanced Interstitial Lung Disease (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_877;
Within the cohort who died, the median age at diagnosis was 74 years (IQR 68-82 years), all were men, 69% had idiopathic pulmonary fibrosis, 65% received pirfenidone, 4% nintedanib, and 31% mycophenolate mofetil...No patients received palliative medications, including morphine, oxycodone, fentanyl and dilaudid, outside of palliative care or hospice...Over half of veterans at this center who died following initiation of advanced ILD therapies had been referred to palliative care. Given the high mortality of ILD in this population, attention should be paid ensuring that all veterans have the opportunity to avail themselves of this service.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015. (Pubmed Central) - Jul 4, 2020
Distribution of naloxone and reported use of naloxone to reverse opioid-involved overdoses increased significantly while the number of opioid-involved and fentanyl-involved overdose deaths did not. Community-based programs that provide training and naloxone to people who use drugs can serve as an early warning system for overdose risk and adaptively respond to the rapidly changing overdose risk environment.
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