The effects of fentanyl anesthesia on the changes of hemodynamic(HR, BP), blood suger, electrolytes and ABGA during induction of anesthesia and cardiopumonary bypass under fentanyl anesthesia were studied in three groups of 30 patients. The results were as follows: 1) The changes of HR & BP were significatly decreased under fentanyl anesthesia compaired to morphine anesthesia. 2) The level of blood sugar was increased during whole procedures in all groups and it was the least in large dose fentanyl group. 3) The changes of electrolyte and arterial blood gas value during CPB were not remakable.
Anesthesia* ; Blood Glucose* ; Electrolytes ; Fentanyl* ; Humans ; Morphine

BACKGROUND: Tracheal intubation can cause sympathetic stimulation such as hypertension and tachycardia. Many drug are used for reducing the incidence of hypertension and tachycardia induced by intubation. Among these drugs, fentanyl can be used with good result. The purpose of this study was to find the appropriate fentanyl injection time before intubation when a small dose (3 microgram/kg) was used. METHODS: We studied 82 ASA class 1 2 patients, scheduled for gynecological elective surgery, randomized into 5 groups. Group 1 received no fentanyl before intubation, and groups 2, 3, 4 and 5 received 3 microgram/kg fentanyl at 7 min, 5 min, 3 min and 1 min before intubation, respectively. The blood pressure and heart rate were checked at preinduction and post-intubation periods for 5 minutes. RESULTS: The increase of the heart rate was significantly lower in groups 2 and 3 than in group 5 just after intubation. Furthermore the increase of the mean blood pressure was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. The incidence of tachycardia and hypertension was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. CONCLUSIONS: When a small dose of fentanyl was used to blunt the intubation induced sympathetic stimulation, the appropriate time was prior to 3 minutes before intubation.
Blood Pressure ; Fentanyl* ; Heart Rate ; Humans ; Hypertension* ; Incidence* ; Intubation* ; Tachycardia*

Meta-analysis is the statistieal analysis of a collection of analytic result for the purpose of integrating the findings across studies. Such a systematic quantitative procedure through combination of statistic offers accumulation of evidence in terms of the effect size. Furthermore, the combination of data from several studies increases generalibility and statistical power with some criticisms. Schmidt-Hunter procedure is appropriate method for measuring d(the difference between the group mean divided by the standard deviation) statistics. In this paper we present the cumulation formulas for effect sizes and analyzed mean d statistics. Twenty-five research reports of clinical trials for prevention of hemodynamie changes after tracheal intubation were gathered. Three drugs(lidocaine, fentanyl, esmolol) were reported in detail sufficient to get for analyzing variables(systolic, diastolic and heart rate). Means of each variable were summarized and calculated by each drug between control and treatment group. Nine meta-analysis were performed. Lidocaine, fentanyl and esmolol all effectively decreased hemodynamic changes compared to control group(placebo group). Fentanyl provided reliable protection in systolic blood pressure as esmolol in heart rate. Range variation.of mean effect size was smallest and consistent in esmolol group. Variance of the effect size corrected for sampling error was large in all drugs and there should be a search for moderator variables(covariate) with need for stratification.
Blood Pressure ; Fentanyl ; Heart ; Heart Rate ; Hemodynamics* ; Intubation* ; Lidocaine ; Research Report ; Selection Bias

BACKGROUND: The aim of this study was to examine the safety and efficacy of sedation and analgesia using remifentanil during percutaneous endoscopic lumbar discectomy (PELD). METHODS: Eighty ASA patients with physical status 1 or 2 who underwent a PELD were enrolled in this study. They were randomized to receive one of two treatments: a fentanyl bolus of 0.7microgram/kg 5 min before the procedure and of 0.7microgram/kg during the procedure (n = 40, group F), or a remifentanil titration at an infusion rate of 0.1-0.3microgram/kg/min available throughout the procedure according to the appeal of pain, level of sedation and side-effects (n = 40, group R). The observer's assessment of alertness/sedation (OAA/S) scale, blood pressure, heart rate, respiratory rate, SpO2, and end tidal CO2 were assessed and measured during and/or after the procedures. The visual analogue scale of pain (VAS), and the patient and endoscopist satisfaction scale were assessed after the procedures. RESULTS: There were no significant differences between the two groups in terms of the recovery characteristics, incidence of complications and satisfaction score of patients. In 92.5% of the cases among the remifentanil group, the spine surgeon made uniform judgements that remifentanil worked better than the usually used fentanyl procedure, whereas in 7.5% of the cases the effects were indifferent. The VAS score of the R group was significantly lower than that of the F group. CONCLUSIONS: We concluded that sedation and analgesia with remifentanil is very useful for painful local procedures such as PELDs.
Analgesia ; Blood Pressure ; Diskectomy* ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Respiratory Rate ; Spine

BACKGROUND: The various methods have been used to prevent or minimize the increase of blood pressure and heart rate to endotracheal intubation. Opioids are the most widely used drug for hemodynamic stability. The purpose of this study was to compare the effects of fentanyl with those of alfentanil on hemodynamic changes to induction of anesthesia and endotracheal intubation. METHODS: Forty five patients were divided into three groups. They received intravenous fentanyl 1.0 microgram/kg, alfentanil 5 microgram/kg or saline 10 ml (control group), respectively. Baseline mean arterial blood pressure and heart rate were measured before the induction of anesthesia. Tracheal intubation was done 3 min after the injection of muscle relaxant. Mean arterial blood pressure and heart rate were measured every minute for 3 min after the induction of anesthesia and tracheal intubation and the results were compared with baseline value. RESULTS: Mean arterial blood pressure decreased significantly compared with baseline value after the induction of anesthesia, but there were no significant differences among the three groups. Heart rate initially increased and then decreased. After tracheal intubation, mean blood pressure and heart rate increased significantly in all groups. The extent of this was significantly lower in the alfentanil group and slightly lower in the fentanyl group than in the control group. CONCLUSIONS: Alfentanil is more effective than fentanyl at inhibiting cardiovascular responses following intubation, but further studies are needed to define the optimal injection time and drug dosage.
Alfentanil* ; Analgesics, Opioid ; Anesthesia* ; Arterial Pressure ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal*

BACKGROUND: Somatosensory evoked potential (SSEP) has been used to help minimize neurologic morbidity during spinal surgery. But, SSEP is affected by various factors, namely technical errors, anesthetics and physiologic aspects (systemic blood pressure, temperature, blood gas tensions). We experienced 40 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. We reviewed these cases with the availability of total intravenous anesthesia during SSEP monitoring. METHODS: Forty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl, and monitored by SSEP. We recorded latency and amplitude of SSEP in the pre-induction, post-induction, during-instrument insertion and post-distraction periods. RESULTS: There were no statistical differences in latencies among pre-induction, post-induction, screw insertion and post-distraction period. The amplitude of the post-induction period was statistically higher than pre-induction period (p<0.05), but there were no differences in other periods. None of cases showed abnormal findings (i.e., delay of latency over 10% or decrease of amplitude over 50%). CONCLUSIONS: SSEP monitoring may be helpful in identifying potentially neurologically threatening surgical maneuvers during spinal surgery. To achieve better outcomes, we should consider the effects of various factors on SSEP. Total intravenous anesthesia may be useful method, which has lifter influence on SSEP monitoring.
Anesthesia, General ; Anesthesia, Intravenous* ; Anesthetics ; Blood Pressure ; Evoked Potentials* ; Evoked Potentials, Somatosensory ; Fentanyl ; Humans ; Propofol

Serum epinephrine and norepinephrine concentrations were measured in 7 patients during fentanyl-oxygen anesthesia, who were undergoing elective open heart surgery(single valvular replacement operations) in Seoul National University Hospital. Sampling times and corresponding total fentanyl doses were as follows; 1) after arterial cannulation 2) 5 minutes after intubation(50 ug/kg of B. Wt) 3) 5 minutes after sternotomy(65 ug/ka) 4) after aortic dissection(75 ug/kg) 5) 15 minutes after initiating bypass 6) 60 minutes after initiating bypass [20 ug/kg of fentanyl was added to the priming solution before initiation of Cardio-pulmonary bypass(CP bypass)]. High Performance Liquid Chromatography(HPLC) was used to analyze hormones. Epinephrine concentrations(pg/ml) corresponding to the sampling times were as follows (mean+/-SE); 1) 213+/-59 2) 199+/-62 3) 246+/-83 4) 173+/-35 5) 270+/-70 6) 269+/-70 Norepinephrine concentrations(pg/ml) were as follows(mean+/-SE); 1) 609+/-107 2) 500+/-73 3) 645+/-152 4) 470+/-82 5) 494+/-65 6) 955+/-311 There were no significant hormonal changes except the 6th norepinephrine value. There were no significant hemodynamic changes except blood pressure decrease at the beginning of CP bypass. It is concluded that high dose fentanyl-oxygen anesthesia was limitedly effective to block the stress of open heart surgery, general anesthesia and CP bypass.
Anesthesia* ; Anesthesia, General ; Blood Pressure ; Catheterization ; Epinephrine ; Fentanyl* ; Heart* ; Hemodynamics ; Humans ; Norepinephrine ; Oxygen* ; Seoul ; Thoracic Surgery*

BACKGROUND: Remifentanil is a new member of fentanyl family and a short-acting, esterase-metabolized opioid.This study compared the perioperative characteristics of a remifentanil infusion with those of fentanyl bolus administration as an adjuvant to propofol infusion for the anesthetic management of patients undergoing ureteroscopic lithotripsy. METHODS: Eighty patients were randomly assigned to receive either remifentanil target controlled infusion (R group, effect-site concentration of 4.0 ng/ml for induction followed by 2.0 ng/ml) or fentanyl bolus (F group, 2.0microgram/kg before induction).All patients received propofol infusion as the part of the induction and maintenance.We investigated recovery profiles, adverse events and the ease of insertion of laryngeal mask airway (LMA) between the two groups.Heart rate (HR) and mean blood pressure (MBP) were also compared at baseline (T0), loss of consciousness (T1), insertion of LMA (T2), beginning and end of operation (T3, T4) and removal of LMA (T5). RESULTS: The time from the end of anesthesia to spontaneous respiration, eye opening and LMA removal were significantly shorter for patients receiving remifentanil than for those receiving fentanyl.HR at T3 and T4 were lower in the R group than in the F group.Aldrete recovery score, time to discharge from recovery ward, the ease of insertion of the LMA, MAP and adverse events did not differ significantly between the two groups. CONCLUSIONS: Target controlled infusion of remifentanil combined with propofol can significantly shorten the early recovery time than fentanyl bolus administration without increasing adverse events in patients undergoing ureteroscopic lithotripsy.
Anesthesia ; Blood Pressure ; Eye ; Fentanyl ; Humans ; Laryngeal Masks ; Lithotripsy ; Piperidines ; Propofol ; Respiration ; Unconsciousness

BACKGROUND: To test whether smokers have exaggerated hemodynamic responses to induction and intubation, we investigated the changes in blood pressure (BP) and heart rate (HR) on induction and intubation in smokers and nonsmokers. METHODS: Healthy male patients (25 smokers and 25 nonsmokers, aged 20 to 29 yrs) for elective surgery were studied. Anesthesia was induced with thiopental 3 mg/kg, fentanyl 1.5 microgram/kg, vecuronium 0.1 mg/kg and maintained with enflurane 1 % in N2O and O2 for the period of observation. After three minutes, orotracheal intubation was performed. Noninvasive BP and HR were recorded one minute before induction (baseline), immediately before intubation, and then every minute until five minutes after intubation. RESULTS: Systolic BP of smokers decreased significantly immediately before intubation, and at 4 and 5 min after intubation as compared to that of nonsmokers (Mean +/- SEM, 120.8 +/- 3.0 vs. 109.9 +/- 2.8, 116.7 +/- 2.4 vs. 108.9 +/- 2.3, and 114.8 +/- 2.2 vs. 106.7 +/- 2.3 mmHg, respectively, P < 0.05). Diastolic BP of smokers decreased only immediately before intubation compared with that of nonsmokers (Mean +/- SEM, nonsmoker 64.6 +/- 2.4 vs. smoker 58.6 +/- 1.8 mmHg, P < 0.05). However, there was no significant difference of HR between smokers and nonsmokers during the observational period. CONCLUSIONS: Hemodynamic response is different in smokers compared with nonsmokers. Our results indicate that smoking affects the hemodynamic response to induction and intubation.
Anesthesia ; Blood Pressure ; Enflurane ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Male ; Smoke ; Smoking ; Thiopental ; Vecuronium Bromide

BACKGROUND: When given as an intravenous bolus for induction of anesthesia, propofol with fentanyl can induce moderate to severe preintubation hypotension and bradycardia. The goal of this study was to evaluate the effect of ephedrine to prevent hypotension and bradycardia and to compare methods of ephedrine administration. METHODS: Forty five patients of ASA physical status 1 or 2 were randomly assigned to one of three groups of 15 patients each to receive either normal saline (G I), ephedrine 0.2 mg/kg IV 2 min before the injection of propofol (G II), or propofol mixed with ephedrine 0.2 mg/kg (G III). Each group first received fentanyl 2ng/kg and 2 min later received propofol 2 mg/kg as an intravenous bolus to induce anesthesia. Anesthesia was maintained by a continuous infusion of propofol 20 mg for 8 min until intubation. The changes of systolic and diastolic arterial pressure, and heart rate were measured before induction (0 min), 2, 4, 6, and 8 min after induction, and post intubation (10 min). RESULTS: The decrease of systolic and diastolic pressure in G II and G III were attenuated compared with those of the control group. The difference was significant at 2, 4, and 6 min in G II, and at 2 and 4 min in G III (P < 0.05). The decrease of heart rate in G II (8 min) and G III (6 and 8 min) were also less marked than those in G I (P < 0.05). The increase of heart rate of post intubation (10 min) was greater in G II and G III than in G I (P < 0.05). There was no statistical difference among the groups in the increase of systolic and diastolic pressures after intubation. CONCLUSIONS: Prophylactic ephedrine significantly attenuated the decrease in blood pressure and heart rate during induction of anesthesia with fentanyl and propofol. There was no statistical difference between the ephedrine groups.
Anesthesia ; Arterial Pressure ; Blood Pressure* ; Bradycardia ; Ephedrine* ; Fentanyl* ; Heart Rate* ; Heart* ; Humans ; Hypotension ; Hysterectomy* ; Intubation ; Propofol*