OBJECTIVETo compare the efficacy and safety of midazolam combined with fentanyl and propofol combined with fentanyl as conscious sedation in oocyte retrieval of in vitro fertilization and embryo transplantation (IVF-ET).

METHODSEighty patients receiving IVE-ET were randomly divided into midazolam combined with fentanyl group (midazolam group) and propofol combined with fentanyl group (propofol group). Antalgic effects, circulation status (blood pressure, heart rate), respiration status (rate, oxygen saturation and respiration depression) during operation, nausea and vomiting, and amnestic effects after operation were compared.

RESULTNo differences of antalgic effects and circulation status between two groups were observed. Percentages of respiration depression,vomiting and amnesia of midazolam group were 5.0 %, 10.0 % and 25%, respectively, and those of propofol group were 25%, 27.5% and 7.5%, respectively, which had statistical significance.

CONCLUSIONAs conscious sedation, midazolam combined with fentanyl is better than propofol combined with fentanyl in oocyte retrieval of IVF-ET.

Adult ; Anesthetics, Combined ; administration & dosage ; Anesthetics, Intravenous ; administration & dosage ; Female ; Fentanyl ; administration & dosage ; Fertilization in Vitro ; Humans ; Midazolam ; administration & dosage ; Oocyte Retrieval ; methods ; Propofol ; administration & dosage

The transdermal administration of narcotics is one of the alternative ways of providing adequate pain relief for the patients with chronic cancer pain. A Phase 4 trial was conducted to evaluate the efficacy and safety of Fentanyl-TTS in adult patients with cancer-related pain in Korea. METHODS: Patients with histologically confirmed malignancy, who have pain related to the cancer and/or therapy, pain necessitating the use of opoid analgesics, age of 18 yr or older, ability to communicate effectively with study personnel, and signed on informed consent were included. The patients were titrated with a short-acting narcotic to control their cancer pain before they are converted to a fentanyl-transdermal therapeutic system(TTS). Short acting parenteral morphine and MS contin were used as rescue medications. All patients were evaluated initially and were followed up with a pain visual analogue scale(VAS), quality of life(QOL)-VAS. Patients were asked to keep the daily record for 21 days about pain VAS, QOL-VAS, amount of rescue morphine used, and side effects. RESULTS: Twenth two patients were enrolled from January 1996 to October 1997. The dose of fentanyl-TTS required, ranged between 25 and 75 ug/hr (25 microgram/hr in 13, 50 microgram/hr in 4, and 75 microgram/hr in 2). The mean dose of morphine required before the use of the fentanyl-TTS was 135.3 mg (20-285 mg/day), but it was decreased after the use of the fentanyl-TTS. Pain VAS and QOL-VAS were in adquate level during the fentanyl- TTS treatment. Patients favored continuous use of fentanyl after the study was finished. Side effect of fentanyl-TTS was minimal. CONCLUSION: Transdermal fentanyl seems to be a convenient and effective analgesic for the control of cancer related pain in Korean. A controlled trial comparing fentanyl-TTS to morphine needs to be followed.
Administration, Cutaneous ; Adult* ; Analgesics ; Fentanyl ; Humans ; Informed Consent ; Korea ; Morphine ; Narcotics

BACKGROUND: Compared with conventional routes of delivering potent analgesics to postoperative patients, transdermal administration of fentanyl offers the advantages of simplicity and noninvasiveness. The analgesic efficacy and safty of transdermal fentanyl patch (TDFP) were evaluated postoperatively. METHOD: TDFP releasing 25 mcg/hr (Group 1) or placebo (Group 2) were applied to 40 women 6 hours before total abdominal hysterectomy under the general anesthesia. Postoperatively, self-administered intravenous fentanyl was maintained with a 20-mcg incremental dose and a 10-min. locking interval. Each group was assessed following 48 hours with respects to vital signs, VAS pain scores, hourly-used fentanyl doses, satisfaction scores and side effects. RESULT: VAS observed 24 hours, 36 hours after operation were significantly lower in group 1 than group 2. Hourly-used fentanyl doses were significantly lower in group 1 than group 2 at 2 hours, 6 hours, 12 hours and 24 hours after operation. The incidence of side effects were similar between group 1 and group 2. CONCLUSION: TDFP-25 mcg applied 6 hours before operation provides supplementary analges-ia after the postoperative period without significant side effects such as respiratory depression.
Administration, Cutaneous ; Analgesics ; Anesthesia, General ; Female ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Postoperative Period ; Respiratory Insufficiency ; Vital Signs

Fentanyl, a synthetic, highly selective opioid micro-receptor agonist, is 50 to 100 times more potent than morphine. The low molecular weight, high potency, great transdermal permeation rate and lipid solubility of fentanyl make it very suitable for transdermal administration. Durogesic is a novel matrix transdermal system providing continuous systemic delivery of fentanyl. In recently, there are many reports that misused or overused fentanyl transdermal patches result in severe intoxication of fentanyl. We present a case of fentanyl toxicity with misused durogesic transdermal patch and discuss the safe and appropriate application of the patches. In conclusion, fentanyl patches should be used in opioid tolerant patients and prescribed at the lowest possible dose and titrated upward as needed. All patients and their caregivers should be educated safe application of fentanyl patches and advised to avoid exposing the patches application site to direct external heat sources, such as heating pads, or electric blankets, heat lamps, sauna, hot tubs, and others. In addition, concomittant medications that affect fentanyl's metabolism should be avoided.
Administration, Cutaneous ; Caregivers ; Fentanyl ; Heating ; Hot Temperature ; Humans ; Molecular Weight ; Morphine ; Solubility ; Steam Bath ; Transdermal Patch

BACKGROUND: One of the goals of anesthesia is a complete, comfortable, and rapid recovery without sequelae from anesthesia. Perioperative intravenous fentanyl treatment, due to its rapid onset and brief duration of action, is the one of the most commonly used narcotics. However, the dosage of fentanyl used varies a great deal depending on the purpose and plan of postoperative pain management. When a large dose of fentanyl is used, delayed emergence may occur. This study is designed to evaluate the effective dose of fentanyl and ketorolac for postoperative analgesia. METHODS: Sixty ASA physical status 1 or 2 patients were divided into three groups: fentanyl group (fentanyl 2micro gram/kg, n = 20), mixed group (fentanyl 1micro gram/kg and ketorolac 0.5 mg/kg, n = 20) or ketorolac group (ketolorac 1 mg/kg, n = 20). Each group received a drug ten minutes before the expected termination of the surgical procedure. At the operating room, durations for return of spontaneous breathing, spontaneous eye opening, and extubation were evaluated. At the recovery room, VAS (Visual Analogue Scale) and K-MMSE (Korean Minimental Status Exam) were measured. RESULTS: When compared to the ketolorac group, return times of the spontaneous breathing, spontaneous eye opening, and extubation were prolonged in the fentanyl group (P < 0.05). In the mixed group, the duration of these parameters was intermediate. Postoperative pain scores were also significantly lower in the fentanyl group and mixed group than in the ketorolac group (P < 0.05). The K-MMSE scores for emergence from anesthesia were not significantly different between the three experimental groups. CONCLUSIONS: Based on these results, we suggest that intravenous administration of reduced doses of fentanyl and ketorolac could effectively reduce the pain score without delay from emergence.
Administration, Intravenous ; Analgesia* ; Anesthesia ; Fentanyl* ; Humans ; Ketorolac* ; Narcotics ; Operating Rooms ; Pain, Postoperative ; Recovery Room ; Respiration

BACKGROUND: One of the goals of anesthesia is a complete, comfortable, and rapid recovery without sequelae from anesthesia. Perioperative intravenous fentanyl treatment, due to its rapid onset and brief duration of action, is the one of the most commonly used narcotics. However, the dosage of fentanyl used varies a great deal depending on the purpose and plan of postoperative pain management. When a large dose of fentanyl is used, delayed emergence may occur. This study is designed to evaluate the effective dose of fentanyl and ketorolac for postoperative analgesia. METHODS: Sixty ASA physical status 1 or 2 patients were divided into three groups: fentanyl group (fentanyl 2micro gram/kg, n = 20), mixed group (fentanyl 1micro gram/kg and ketorolac 0.5 mg/kg, n = 20) or ketorolac group (ketolorac 1 mg/kg, n = 20). Each group received a drug ten minutes before the expected termination of the surgical procedure. At the operating room, durations for return of spontaneous breathing, spontaneous eye opening, and extubation were evaluated. At the recovery room, VAS (Visual Analogue Scale) and K-MMSE (Korean Minimental Status Exam) were measured. RESULTS: When compared to the ketolorac group, return times of the spontaneous breathing, spontaneous eye opening, and extubation were prolonged in the fentanyl group (P < 0.05). In the mixed group, the duration of these parameters was intermediate. Postoperative pain scores were also significantly lower in the fentanyl group and mixed group than in the ketorolac group (P < 0.05). The K-MMSE scores for emergence from anesthesia were not significantly different between the three experimental groups. CONCLUSIONS: Based on these results, we suggest that intravenous administration of reduced doses of fentanyl and ketorolac could effectively reduce the pain score without delay from emergence.
Administration, Intravenous ; Analgesia* ; Anesthesia ; Fentanyl* ; Humans ; Ketorolac* ; Narcotics ; Operating Rooms ; Pain, Postoperative ; Recovery Room ; Respiration

BACKGROUND: Sevoflurane anesthesia is associated with emergence agitation in children. In this study, we compared the emergence and recovery profiles of children who received sevoflurane with fentanyl or alfentanil for inguinal herniorrhaphy. METHODS: Forty-five children receiving sevoflurane anesthesia for inguinal herniorraphy were assigned to three groups. Saline 0.1 ml/kg (group S), alfentanil 10microgram//kg (group A) or fentanyl 1microgram//kg (group F) was administered intravenously at the beginning of fascia closure. Duration of operation and anesthesia and emergence time were evaluated at the operating room. Agitation score, a degree of pain, the time of stay in PACU (postanesthetic care unit) and postoperative side effects were evaluated by a blinded observer at the PACU. RESULTS: The emergence time was prolonged in the group F compared to the other groups. The time of stay in PACU was prolonged in the group F compared to the group S. Group A and F had lower agitation score and pain score in comparison with that of the group S at the 0, 5, 10, 15 min in the PACU. Agitation score was also significantly lower in the group F compared to the group A at 30 min. CONCLUSIONS: We suggest that intravenous administration of alfentanil 10microgram//kg or fentanyl 1microgram//kg at the closure of fascia could effectively reduce the agitation score. Alfentanil also does not delay from emergence and the time of stay in the PACU.
Administration, Intravenous ; Alfentanil* ; Anesthesia* ; Child* ; Dihydroergotamine* ; Fascia ; Fentanyl ; Herniorrhaphy ; Humans ; Operating Rooms

BACKGROUND: We postulated that ketorolac as a component of surgical site infiltration would result in better analgesia than intravenous ketorolac. METHODS: Sixty patients who scheduled for elective total abdominal hysterectomy received ketorolac 60 mg (2 ml) either via surgical site infiltration directly (n=30) or parenteral route (n=30) with surgical site infiltration of 0.25% bupivacaine 18 ml 20 min before skin incision. RESULTS: Postoperative analgesic requirement, 48 hour total infusion dose and first 12 hour infusion dose of PCA fentanyl, were significantly lower in surgical site group. There were no significant differences in VAS score and side effects between two groups. CONCLUSION: Ketorolac improves analgesia when it is administered in the surgical site.
Administration, Intravenous* ; Analgesia ; Bupivacaine* ; Fentanyl ; Humans ; Hysterectomy ; Ketorolac* ; Passive Cutaneous Anaphylaxis ; Skin

Administration, Cutaneous ; Adolescent ; Adult ; Analgesia ; methods ; Female ; Fentanyl ; administration & dosage ; Humans ; Male ; Pain, Postoperative ; prevention & control ; Tonsillectomy ; methods ; Young Adult

OBJECTIVETo summarize the anesthetic management in fetal lamb cardiac bypass.

METHODSFive ewes at 120-140 days of gestation were anesthetized intramuscularly with katamine hydrochloride, intubated and ventilated with a respirator. Anesthesia was maintained with fentanyl and vecuronium. Lactated Ringer's solution and magnesium sulfate were infused to maintain the mean blood pressure (MAP) over 70 mmHg and uterine relaxation. The fetal lambs received anesthesia with fentanyl and vecuronium intramuscularly via the uterine wall. Fetal cardiac bypass was established with pulmonary artery and right atrium cannulation, lasting for 30 min. The hemodynamic and blood gas data of the ewes and fetal lambs were recorded before bypass, at 30 min during bypass, and at 1 and 2 h after cessation of bypass. The pulse index of the umbilical artery (PIua) and the ewe's uterine artery (PIeu) were monitored simultaneously.

RESULTSThe MAP and heart rate (HR) of the fetus remained normal during the anesthesia. PIua increased significantly after cessation of bypass (P<0.05). Although the fetal oxygen tension in the axillary artery remained normal, the fetal lambs showed hypercarbia and acidosis after cessation of bypass (P<0.05). The maternal MAP and HR remained normal. The PIeu decreased significantly during bypass (P<0.05) and recovered the normal level after cessation of bypass. The arterial blood gas of the ewes was normal during the experiment.

CONCLUSIONMaintaining high hemodynamics in the ewes, application of uterine relaxation and intensive care during anesthesia are crucial in anesthetic management of cardiac bypass in fetal lambs.

Anesthetics, Dissociative ; Animals ; Cardiopulmonary Bypass ; methods ; Female ; Fentanyl ; administration & dosage ; Fetal Heart ; surgery ; Goats ; surgery ; Ketamine ; administration & dosage ; Pregnancy ; Vecuronium Bromide ; administration & dosage