- |||||||||| fentanyl citrate / Generic mfg.
Journal: Reported Xylazine Use Among Adults Aged ?18 Years Evaluated for Substance Use Treatment - United States, July 2022-September 2023. (Pubmed Central) - Jul 3, 2024
Xylazine has been increasingly detected in illegally manufactured fentanyl (IMF) products and overdose deaths in the United States; most xylazine-involved overdose deaths involve IMF...Among adults reporting IMF or heroin use recently or as their primary lifetime substance-use problem, those reporting xylazine use reported a median of two past nonfatal overdoses from any drug compared with a median of one overdose among those who did not report xylazine use; as well, higher percentages of persons who reported xylazine use reported other recent substance use and polysubstance use. Provision of nonjudgmental care and services, including naloxone, wound care, and linkage to and retention of persons in effective substance use treatment, might reduce harms including overdose among persons reporting xylazine use.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: When Are "Paraphernalia" Critical Medical Supplies? (Pubmed Central) - Jul 3, 2024
But lack of consistency among states' laws means that patients' interstate travel can subject them to being charged with possession of illegal items. This commentary on a case offers guidance to clinicians looking to help patients understand legal risks of interstate travel with supplies that are prescribed or recommended to reduce harms of their drug use and explores the ethical responsibilities of physicians in jurisdictions that legally prohibit these harm reduction interventions.
- |||||||||| fentanyl citrate / Generic mfg., ketamine / Generic mfg.
Journal: Do Patients With Mental Illness Undergoing Office-Based Sedation Require an Increased Propofol Dosage? (Pubmed Central) - Jul 2, 2024
This commentary on a case offers guidance to clinicians looking to help patients understand legal risks of interstate travel with supplies that are prescribed or recommended to reduce harms of their drug use and explores the ethical responsibilities of physicians in jurisdictions that legally prohibit these harm reduction interventions. The findings suggest that a patient's mental illness may influence the amount of sedative required to achieve satisfactory anesthesia.
- |||||||||| fentanyl citrate / Generic mfg., methamphetamine / Generic mfg.
Journal: Safety strategies and harm reduction for methamphetamine users in the era of fentanyl contamination: A qualitative analysis. (Pubmed Central) - Jun 28, 2024
Additionally, our results indicate that harm reduction behaviors are influenced by multilevel risk environments, which include social, physical, economic, and political factors. Overall, these results highlight the potential for targeted interventions at the network level, which are responsive to complexities and shifts in drug market dynamics- such as illicit fentanyl in methamphetamine.
- |||||||||| Journal: Treating Benzodiazepine Withdrawal in a Bridge Clinic. (Pubmed Central) - Jun 26, 2024
Managing benzodiazepine withdrawal with a 4- to 6-week intensive outpatient taper in patients with benzodiazepine and opioid use disorders is challenging. More work is needed to refine patient selection, balance safety risks with feasibility, and study long-term, patient-centered outcomes.
- |||||||||| diphenhydramine / Generic mfg.
Review, Journal: Treating Diphenhydramine Overdose: A Literature Review of Currently Available Treatment Methods. (Pubmed Central) - Jun 26, 2024
The treatments reviewed include the more traditional antihistamine overdose therapeutics physostigmine and sodium bicarbonate, as well as newer ones such as donepezil, dexmedetomidine, and lipid emulsion therapy. We conclude that more study is needed to determine the ideal therapeutic approach to treating antihistamine overdoses.
- |||||||||| The Elderly Nursing Home Patient With Dementia Has a Hip Fracture: What Are the Anesthetic Considerations? (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_3255;
Medications include Coumadin, Metoprolol, Donepezil...Risk of delirium in moderate sedation cases has shown to increase with addition of other agents include fentanyl, midazolam, ketamine and precedex...If so, which opioid would you choose?How much opioid is appropriate to place into the intrathecal space?Would a pre operative regional technique be beneficial for this patient? If so, which one?
- |||||||||| morphine sulphate / Generic mfg.
Symptomatic Catheter Tip Granuloma in a Patient With High Dose Intrathecal Morphine Therapy: To Explant or Not to Explant (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_3143;
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...This case discusses the use of the combination of long- and short-acting oral opioids in the process of rapid weaning off intrathecal opioids in a patient with an IDDS.CASE HISTORYThe 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...Will you agree?9)Why did this patient develop granuloma at the tip of intrathecal catheter in the first place? 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 prevent formation of granuloma in other patients.1
- |||||||||| Tracleer (bosentan) / J&J, Roche, Bridion (sugammadex) / Merck (MSD)
Considerations in the Management of a Down Syndrome Patient With Severe Pulmonary Hypertension Presenting With an Acute Abdomen (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_3042;
Her medications include sildenafil, bosentan, treprostinil, levothyroxine, and ranitidine...You give two mg of Midazolam, 50 mg of Ketamine, 50 mcg of Fentanyl, 50 mg of Rocuronium, and start Propofol infusion at 200 mcg/kg/min...Why?-What would you do for pain control?-What would be your post-op disposition for this patient?Intraoperative continued: You decide to perform awake extubation, so you discontinue Propofol infusion and give Sugammadex for reversal...ABG shows pH 7.35, PaCO2 40, PaO2 85, BE -3, and lactate 2. You extubate the patient and transfer to CICU in stable condition.
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., heparin sodium injection / Generic mfg.
Pain Management Strategies in the Opioid Dependent Parturient (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_3030;
Platelet count was within normal limits prior to epidural catheter removal. The patient and her infant were discharged home later the following day.
- |||||||||| morphine sulphate / Generic mfg.
Symptomatic Catheter Tip Granuloma in a Patient With High Dose Intrathecal Morphine Therapy: To Explant or Not to Explant (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_3028;
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...This case discusses the use of the combination of long- and short-acting oral opioids in the process of rapid weaning off intrathecal opioids in a patient with an IDDS.CASE HISTORYThe 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...Will you agree?9)Why did this patient develop granuloma at the tip of intrathecal catheter in the first place? 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 prevent formation of granuloma in other patients.1
- |||||||||| fentanyl citrate / Generic mfg., buprenorphine/naloxone sublingual film / Generic mfg., methadone / Generic mfg.
Approach to the Parturient With Opioid Use Disorder (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_3026;
The obstetricians request bringing the patient to the operating room immediately for emergent cesarean delivery without neuraxial anesthesia.How would you prepare this patient for surgery? How would you plan to manage the patient
- |||||||||| Zepatier (grazoprevir/elbasvir) / Merck (MSD)
Hepatectomy for a Patient With Hepatocellular Carcinoma (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2863;
He has history of hepatitis C virus with sustained virologic response (SVR) after a course of treatment with ledipasvir/sofosbuvir, and hepatocellular carcinoma that recurred despite treatment with transarterial chemoembolization (TACE)...What is elbasvir/grazoprevir?...The nurse inquires if you need blood products for this case.7) What is your vascular access of choice?8) Will you place a central venous catheter?9) Do you need to measure central venous pressure (CVP) during the procedure?10) Does the position of the tumor alter your anesthetic plan?11) What blood products would you order for this case?You place an 18-gauge IV in the holding area and sedate the patient with 2 mg of midazolam...You perform a spinal anesthetic with 250 micrograms of preservative free morphine then perform a smooth induction of anesthesia with propofol, lidocaine, fentanyl and rocuronium. You then place an arterial line, a 16 Ga IV, and initiate maintenance of anesthesia with isoflurane.12) Will you maintain the patient with crystalloid or colloid?13) How will you manage intraoperative fluid administration?14) Should you utilize cell salvage?After nearly 2 hours of dissection, the patient
- |||||||||| fentanyl citrate / Generic mfg., ketamine / Generic mfg., epinephrine / Generic mfg.
Labor Epidural Struggles Lead to C-Section Troubles (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2855;
You then place an arterial line, a 16 Ga IV, and initiate maintenance of anesthesia with isoflurane.12) Will you maintain the patient with crystalloid or colloid?13) How will you manage intraoperative fluid administration?14) Should you utilize cell salvage?After nearly 2 hours of dissection, the patient A test dose of lidocaine 1.5% with 1:200,000 epinephrine was administered and no increases in heart rate or profound lower extremity weakness was noted...What medications can be given?After administration of fentanyl 100 mcg, ketamine 20 mg, and inhaled nitrous oxide 50%, the patient is still uncomfortable and asks if she can
- |||||||||| fentanyl citrate / Generic mfg., rocuronium / Generic mfg.
Multiple Challenges During Trans-catheter Pulmonary Valve Implantation for Severe Stenosis and Regurgitation of an RV-PA Conduit (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2669;
A test dose of lidocaine 1.5% with 1:200,000 epinephrine was administered and no increases in heart rate or profound lower extremity weakness was noted...What medications can be given?After administration of fentanyl 100 mcg, ketamine 20 mg, and inhaled nitrous oxide 50%, the patient is still uncomfortable and asks if she can The patient had inhalation induction, followed by IV placement, Fentanyl 50
- |||||||||| Emla-cream / Akorn, AstraZeneca, Spravato (esketamine intranasal) / J&J
I Didn (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2667;
First, we applied EMLA cream one hour before the surgery...After the time-out, we administered Fentanyl at a dose of 2 mcg/kg, followed by a propofol bolus of 4 mg/kg and a Remifentanil bolus of 1 mcg/kg...Sevoflurane was also started at an inspiratory level of 4%...However, to cover any potential bacterial cause, the patient received ceftriaxone and erythromycin according to local antibiotic treatment guidelines...A chest X-ray was taken five weeks after the initial anesthesia to assess any signs of lingering pneumonia.Pre-Treatment: The patient will receive pre-treatment with salbutamol/albuterol 24 hours before surgery.Anesthesia Team: A second anesthesiologist will be present throughout the procedure, and all necessary medications (including succinylcholine, intravenous salbutamol/albuterol, magnesium, adrenaline, and esketamine) will be readily available for administration in the operating room.High Alert: The procedure will be promptly canceled at the first indication of any complications.Clinical Admission: Instead of an outpatient setting, the procedure will be performed during a clinical admission.Eight weeks after the initial anesthesia, the tonsillectomy was successfully completed without incident, both during the operation and in the post-surgical period. Furthermore, the patient remains healthy, exhibits no neurological symptoms, and continues to develop similarly to their twin sibling.
- |||||||||| Catastrophic Airway Emergency and Bleeding in Endotracheal Tube After Pulmonary Angioplasty in the Cardiac Catheterization Laboratory! What Is Next? (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2563;
Case Description:A 14-year-old girl, who has a previous medical history of DiGeorge syndrome, Tetralogy of Fallot, and MAPCAs, repaired by Unifocalization, right ventricle to pulmonary artery (RV-PA) Conduit, and VSD repair in 2009, presented for elective left pulmonary artery (LPA) rehabilitation and pulmonary vasodilator testing in the interventional cardiac catheterization lab.Her history of cardiac repairs and interventions included; Unifocalization and RV-PA conduit (2009), Left BT shunt to left pulmonary artery (LPA), right pulmonary artery (RPA) angioplasty, RV-PA replacement (2011), Unifocalization LUPA, RV-PA conduit replacement (2021), VSD patch (2022), and multiple catheterization-based interventions for RPA / RPV stenosis.Her medications included home oxygen, sildenafil and furosemide...Qp:Qs 1.5After uneventful induction with IV midazolam, fentanyl, propofol and rocuronium, and endotracheal intubation the anesthesia maintenance was conducted by 1% Sevoflurane and boluses of rocuronium...Was there further patient optimization in preparation for the procedure? What could be done better next time?
- |||||||||| fentanyl citrate / Generic mfg., metformin / Generic mfg.
Back on the Block: Multimodal Analgesia for Spine Surgery in a Patient With Opioid Use Disorder (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2553;
Her daily medication includes buprenorphine for maintenance of opioid use disorder, inhaled albuterol for asthma, and metformin for diabetes mellitus.1...The fentanyl infusion is stopped during the beginning of surgical closure...The patient is breathing spontaneously, follows commands, and is extubated successfully.27. What is your plan for postoperative analgesia?
- |||||||||| fentanyl citrate / Generic mfg., midazolam hydrochloride / Generic mfg.
Perioperative Management of the Lactating Patient (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2545;
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., morphine sulphate / Generic mfg., bupivacaine/dextrose / Generic mfg.
Inadequate Spinal Anesthesia for Elective Cesarean Section: Mechanisms and Management (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2541;
What are the factors - including adjunct drugs and different maneuvers - that influence onset, duration, quality, and distribution of a spinal block? 7.What things, if any, should the patient be counseled to tell future anesthesiologists?
- |||||||||| fentanyl citrate / Generic mfg., epinephrine / Generic mfg.
Intrathecal Catheter in Labor? Leave It and Love It! (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2379;
Will you remove the catheter postoperatively? What are the risks and benefits of leaving the catheter in versus removing it?19.What postpartum follow up will you provide for this patient?
- |||||||||| fentanyl citrate / Generic mfg., sevoflurane / Generic mfg., rocuronium / Generic mfg.
An Unanticipated Critically Obstructed Neonatal Airway. A Missed Opportunity for an Exit Procedure (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2369;
(How would you mange anesthesia and the airway at this point ??.) The anesthesia team continued positive pressure mask ventilation, started Sevoflurane anesthesia while maintaining spontaneous respiratory drive...Rocuronium and Fentanyl were then administered and the newborn was transferred in a stable condition to the neonatal ICU...What are the airway management options for the infant during EXIT-to Airway procedure ?? What else could be done if intubation and tracheostomy are both impossible?$$graphic_{4CACF98A-2538-4365-B841-F1BAA7DEB457}$$$$graphic_{1C0FB099-9AE8-473F-87A6-0B70C365CC92}$$$$graphic_{1FF1DBBE-20D4-4126-B897-C4BB2CFCA541}$$$$graphic_{39BA95B2-55E8-47D3-8DA1-A26098D0C1AD}$$$$graphic_{93A1B763-CAAA-4A69-BD9F-F7DEC76548F5}$$
- |||||||||| Emla-cream / Akorn, AstraZeneca, Spravato (esketamine intranasal) / J&J
I Didn (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2235;
First, we applied EMLA cream one hour before the surgery...After the time-out, we administered Fentanyl at a dose of 2 mcg/kg, followed by a propofol bolus of 4 mg/kg and a Remifentanil bolus of 1 mcg/kg...Sevoflurane was also started at an inspiratory level of 4%...However, to cover any potential bacterial cause, the patient received ceftriaxone and erythromycin according to local antibiotic treatment guidelines...A chest X-ray was taken five weeks after the initial anesthesia to assess any signs of lingering pneumonia.Pre-Treatment: The patient will receive pre-treatment with salbutamol/albuterol 24 hours before surgery.Anesthesia Team: A second anesthesiologist will be present throughout the procedure, and all necessary medications (including succinylcholine, intravenous salbutamol/albuterol, magnesium, adrenaline, and esketamine) will be readily available for administration in the operating room.High Alert: The procedure will be promptly canceled at the first indication of any complications.Clinical Admission: Instead of an outpatient setting, the procedure will be performed during a clinical admission.Eight weeks after the initial anesthesia, the tonsillectomy was successfully completed without incident, both during the operation and in the post-surgical period. Furthermore, the patient remains healthy, exhibits no neurological symptoms, and continues to develop similarly to their twin sibling.
- |||||||||| fentanyl citrate / Generic mfg., sevoflurane / Generic mfg., rocuronium / Generic mfg.
An Unanticipated Critically Obstructed Neonatal Airway. A Missed Opportunity for an Exit Procedure (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_2227;
(How would you mange anesthesia and the airway at this point ??.) The anesthesia team continued positive pressure mask ventilation, started Sevoflurane anesthesia while maintaining spontaneous respiratory drive...Rocuronium and Fentanyl were then administered and the newborn was transferred in a stable condition to the neonatal ICU...What are the airway management options for the infant during EXIT-to Airway procedure ?? What else could be done if intubation and tracheostomy are both impossible?
- |||||||||| Betadine (povidone iodine) / Egis
Pediatric Trauma for the Non-pediatric Anesthesiologist: Just Another Dog Bite? (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_1852;
Sedation is initiated with infusions of Dexmedetomidine and Fentanyl...The patient has been transferred to the operating room table and the nurse is cleaning the surgical field with Betadine...Would you extubate this patient? Key Question 22: Should the patient be transferred from the operating room to the intensive care unit?
- |||||||||| Anesthetic Considerations for the Transgender Patient: What Do You Need to Know? (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_1848;
Key Question 22: Should the patient be transferred from the operating room to the intensive care unit? Their current medications include oral contraceptives, famotidine, sumatriptan, sertraline, cyclobenzaprine and duloxetine...After several minutes of preoxygenation, anesthesia is induced with cricoid pressure in place with propofol 200mg, fentanyl 150mcg, succinylcholine 100mg and lidocaine 100mg...Upon chart review, you noted that only ondansetron was given for PONV prophylaxis...Their current medications include sertraline, estrogen and spironolactone...(anxiety, myofascial, DVT-PE, aspiration)How will you manage this patient?Let
- |||||||||| The Elderly Nursing Home Patient With Dementia Has a Hip Fracture: What Are the Anesthetic Considerations? (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_1846;
Medications include Coumadin, Metoprolol, Donepezil...Risk of delirium in moderate sedation cases has shown to increase with addition of other agents include fentanyl, midazolam, ketamine and precedex...If so, which opioid would you choose?How much opioid is appropriate to place into the intrathecal space?Would a pre operative regional technique be beneficial for this patient? If so, which one?
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., bupivacaine/dextrose / Generic mfg.
Inadequate Spinal Anesthesia for Elective Cesarean Section: Mechanisms and Management (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_1579;
What are the factors - including adjunct drugs and different maneuvers - that influence onset, duration, quality, and distribution of a spinal block? 7.What things, if any, should the patient be counseled to tell future anesthesiologists?
- |||||||||| fentanyl citrate / Generic mfg., midazolam hydrochloride / Generic mfg.
Perioperative Management of the Lactating Patient (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_1577;
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., ketamine / Generic mfg., epinephrine / Generic mfg.
Labor Epidural Struggles Lead to C-Section Troubles (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_1435;
Abstract is embargoed at this time. A test dose of lidocaine 1.5% with 1:200,000 epinephrine was administered and no increases in heart rate or profound lower extremity weakness was noted...What medications can be given?After administration of fentanyl 100 mcg, ketamine 20 mg, and inhaled nitrous oxide 50%, the patient is still uncomfortable and asks if she can
- |||||||||| Entresto (sacubitril/valsartan) / Novartis, ROVI Pharmaceuticals Laboratories, Jardiance (empagliflozin) / Eli Lilly, Boehringer Ingelheim
Impella Standby and Pharmacologic Support During Mitral Clip Procedure in an Unstable Cardiac Patient (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_1429;
Preoperative medications included: Sacubitril-valsartan (Entresto), Metoprolol, Empagliflozin, Furosemide, Protonix, Sertraline and Digoxin...He then received 150 mg of IV amiodarone load followed by continuous infusion and was taken to the hybrid Cath Lab to undergo a TEE followed by cardioversion and mitral clip application...Anesthesia was induced with etomidate, fentanyl, rocuronium and esmolol...Inotropic support was provided pharmacologically with milrinone and norepinephrine infusions...How can the Impella flow adjustments facilitate mitral clipping. 10-How would you manage new onset hypotension in PACU after extubation.$$graphic_{0ABD30CA-3234-47A0-BF39-C8A2B62426BB}$$$$graphic_{4A201CBB-4F60-48BB-8303-A453EB511991}$$$$graphic_{9098DA9F-016F-4F1F-8A03-547F0E5ED0EB}$$$$graphic_{5A825C96-1CED-4442-9DFB-AA998C5488EE}$$$$graphic_{DE57C476-94EB-4AE3-AE8C-715C50C45F61}$$
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