- |||||||||| Betadine (povidone iodine) / Egis
Everything You Ever Wanted to Know About Perioperative Hypersensitivity Reactions Before It's Too Late (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_1425;
Maintenance included sevoflurane...Preoperatively, betadine skin prep was used, and he was pretreated with corticosteroids and antihistamines...An awake arterial line was placed, and he was then induced with dexmedetomidine, etomidate, and methadone...He was stable for 18 minutes and then hypotensive and tachycardic but responded very rapidly to boluses of epinephrine, vasopressin, phenylephrine and fluid resuscitation...Table 1 summarizes the anesthetics used and the tryptase levels. What is the significance of these results?$$graphic_{906E5046-3C50-4A47-9837-748270DA6A29}$$
- |||||||||| 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_1068;
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_942;
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?
- |||||||||| Anesthetic Considerations for the Transgender Patient: What Do You Need to Know? (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_932;
What is your plan for postoperative analgesia? 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
- |||||||||| Zepatier (grazoprevir/elbasvir) / Merck (MSD)
Hepatectomy for a Patient With Hepatocellular Carcinoma (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_685;
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., epinephrine / Generic mfg.
Intrathecal Catheter in Labor? Leave It and Love It! (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_669;
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?
- |||||||||| Betadine (povidone iodine) / Egis
Pediatric Trauma for the Non-pediatric Anesthesiologist: Just Another Dog Bite? (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_485;
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?
- |||||||||| 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_477;
Platelet count was within normal limits prior to epidural catheter removal. The patient and her infant were discharged home later the following day.
- |||||||||| 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_471;
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.
- |||||||||| Betadine (povidone iodine) / Egis
Everything You Ever Wanted to Know About Perioperative Hypersensitivity Reactions Before It's Too Late (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_469;
Maintenance included sevoflurane...Preoperatively, betadine skin prep was used, and he was pretreated with corticosteroids and antihistamines...An awake arterial line was placed, and he was then induced with dexmedetomidine, etomidate, and methadone...He was stable for 18 minutes and then hypotensive and tachycardic but responded very rapidly to boluses of epinephrine, vasopressin, phenylephrine and fluid resuscitation...Table 1 summarizes the anesthetics used and the tryptase levels. What is the significance of these results?
- |||||||||| 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_128;
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., buprenorphine/naloxone sublingual film / Generic mfg., methadone / Generic mfg.
Approach to the Parturient With Opioid Use Disorder (126A) - Jun 25, 2024 - Abstract #ASA2024ASA_122;
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
- |||||||||| morphine sulphate / Generic mfg.
Journal: Effect of Morphine Used to Relieve Dyspnea Due to Heart Failure on Delirium. (Pubmed Central) - Jun 25, 2024
Morphine, which is used to relieve dyspnea due to heart failure, had minimal effect on the incidence of delirium. This information is likely to be beneficial for the future use of morphine in the management of dyspnea in patients with heart failure.
- |||||||||| fentanyl citrate / Generic mfg., tramadol hydrochloride / Generic mfg.
Journal: Stability and Degradation of Opioids in River Water. (Pubmed Central) - Jun 24, 2024
Overall, degradation rates were 1-4 orders of magnitude lower compared to the reported rates for wastewater systems. These results offer insights into the stability of opioids in freshwater systems and raise questions about the potential effects of their pseudopresence in surface waters on aquatic organisms.
- |||||||||| PK/PD data, Review, Journal: Central Nervous System Medications: Pharmacokinetic and Pharmacodynamic Considerations for Older Adults. (Pubmed Central) - Jun 22, 2024
Important pharmacodynamic changes in older adults include an increased sedative effect of benzodiazepines at a given drug exposure, and a higher sensitivity to mu opiate receptor agonists and to opioid adverse effects. Artificial intelligence, physiologically based pharmacokinetic modeling and simulation, and concentration-effect modeling enabling a differentiation between the pharmacokinetic and the pharmacodynamic effects of aging might help to close some of the gaps in knowledge.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Elucidating the Gas-Phase Behavior of Nitazene Analog Protomers Using Structures for Lossless Ion Manipulations Ion Mobility-Orbitrap Mass Spectrometry. (Pubmed Central) - Jun 22, 2024
2-Benzylbenzimidazoles, or "nitazenes", are a class of novel synthetic opioids (NSOs) that are increasingly being detected alongside fentanyl analogs and other opioids in drug overdose cases...The IMS, solvent, and fragmentation studies provide experimental evidence that nitazenes potentially exhibit three gas-phase protomers. The cyclic IMS capability of SLIM was also employed to partially resolve four sets of structurally similar nitazene isomers (e.g., protonitazene/isotonitazene, butonitazene/isobutonitazene/secbutonitazene), showcasing the potential of using high-resolution IMS separations in MS-based workflows for reference-free identification of emerging nitazenes and other NSOs.
- |||||||||| fentanyl citrate / Generic mfg.
Preclinical, Journal: The difference of addictive behavior of freebase nicotine and nicotine salts in mice base on an aerosol self-administration model. (Pubmed Central) - Jun 19, 2024
In this study, an aerosol self-administered model of mice was constructed, which can be used not only for comparing the effects of freebase nicotine and nicotine salts on the behavior, but also for other addictive drugs, such as fentanyl and cannabis. In addition, this study shows that nicotine salts may be more addictive compared to freebase nicotine, which is a reference for the future use of nicotine salts in tobacco products such as e-cigarettes.
- |||||||||| fentanyl citrate / Generic mfg.
Preclinical, Journal: In Vitro Effects of Fentanyl on Aortic Viscoelasticity in a Rat Model of Melatonin Deficiency. (Pubmed Central) - Jun 19, 2024
Furthermore, an independent effect of naloxone was also detected in the normal rat aortic wall, resulting in reduced E'. Additional studies are needed that may improve the clinical decisions for pain management and anesthesia for certain patients with co-occurring chronic low levels of blood plasma melatonin and some diseases.
- |||||||||| ByFavo (remimazolam) / PAION, Cosmo Pharma, Mundipharma, Pharmascience, Eagle Pharma, remimazolam tosylate (HR-7056) / Jiangsu Hengrui Pharma
Clinical, Journal: Transcutaneous Electrical Acupoint Stimulation Combined with Moderate Sedation of Remimazolam Tosilate in Gastrointestinal Endoscopy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. (Pubmed Central) - Jun 19, 2024
P=N/A
Results also suggest people who co-use illicit opioids and methamphetamine may have the greatest unmet needs and desire for additional harm reduction services. TEAS combined with moderate sedation of remimazolam can provide an ideal sedative effect, which preferably suppresses discomfort caused by gastrointestinal endoscopy and has fewer sedation-related complications.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths. (Pubmed Central) - Jun 17, 2024
P=N/A
In this 12-month multimodal intervention trial involving community coalitions in the deployment of evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group in the context of the Covid-19 pandemic and the fentanyl-related overdose epidemic. (Funded by the National Institutes of Health; HCS ClinicalTrials.gov number, NCT04111939.).
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Wastewater Surveillance for Xylazine in Kentucky. (Pubmed Central) - Jun 17, 2024
In the U.S., xylazine, the veterinary non-opioid sedative, has emerged as a major threat to people who use illicitly manufactured fentanyl and other drugs...These findings may inform regional, national, and international efforts to incorporate wastewater-based drug surveillance. Harm-reduction activities along roadways and other suitable locations may be needed.
- |||||||||| Sublocade (buprenorphine once-monthly depot) / Indivior
Journal: Early Remission of Opioid Use Disorder in an Adolescent Using Buprenorphine Extended - Release Subcutaneous Injection: A Case Report. (Pubmed Central) - Jun 16, 2024
Opioid use disorder (OUD) continues to be a major public health crisis, with the current epidemic being driven by synthetic opioids such as illicitly manufactured fentanyl...This case supports the use of buprenorphine extended-release in pediatric patients who are at high risk. While buprenorphine extended-release injections are not Food and Drug Administration-approved for pediatric patients, the increase in adolescent overdose deaths and lack of access to treatment in this age group support the need for increased research and treatment options for youth with OUD.
- |||||||||| ByFavo (remimazolam) / PAION, Cosmo Pharma, Mundipharma, Pharmascience, Eagle Pharma, Bridion (sugammadex) / Merck (MSD)
Journal, Intubation: A new pharmacological approach for tracheal intubation? (Pubmed Central) - Jun 16, 2024
Together, this combination might offer full reversibility of a 'routine' or a 'rapid-sequence' induction anaesthesia. Whether this is useful, or even safe, requires careful evaluation.
- |||||||||| methadone / Generic mfg.
Journal: Methadone's Resurgence in Bridging the Treatment Gap in the Overdose Crisis: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education, Research, Substance Use, and Addiction). (Pubmed Central) - Jun 15, 2024
Coordinated efforts among policymakers, healthcare providers, and communities are needed to promote the development of accountability measures, incentives, and community involvement to ensure equitable access and quality of care. To truly meet the demand needed to end the existing overdose crisis and enhance accessibility and comprehensive healthcare services, methadone treatment expansion beyond traditional OTP settings into primary care offices and community pharmacies should take place.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: The Lived Experiences of Pregnant and Parenting Women in Recovery Toward Medication Treatment for Opioid Use Disorder. (Pubmed Central) - Jun 15, 2024
Maternal misuse of prescription opioids and illicit drugs such as, heroin and non-pharmaceutical fentanyl analogs has increased in the last 2 decades and one in 5 women reported misuse of opioids...Bridging knowledge gaps will reduce anxieties, fears about neonatal opioid withdrawal syndrome and adverse maternal outcomes. Additionally, a deeper understanding of stigmatization and relationships can inform an integrated patient-centered approach to OUD treatment.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Intravenous Opioid Administration During Mechanical Ventilation and Use After Hospital Discharge. (Pubmed Central) - Jun 14, 2024
Terciles of median daily intravenous fentanyl equivalents during mechanical ventilation...In this retrospective cohort study of patients receiving mechanical ventilation, opioids administered during mechanical ventilation were associated with opioid prescriptions following hospital discharge. Additional studies to evaluate risks and benefits of strategies using lower opioid doses are warranted.
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