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Anesthesia for Patients with Ventricular Assist Devices
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Due to the severity of hemodynamic instability and the individual patient response, induction of anesthesia is often initiated with titrated doses of opioids. Fentanyl citrate (10–20 μg/kg IV) along with a hypnotic drug such as etomidate (0.1–0.3 mg/kg IV) can be used during induction. An alternative is ketamine hydrochloride. End organ unresponsiveness due to depletion of myocardial catecholamines and beta receptor down regulation can unmask ketamine hydrochloride’s direct negative inotropic effect. If ketamine hydrochloride is chosen a dose of 0.5–1 mg/kg should be titrated intravenously. To facilitate tracheal intubation nondepolarizing muscle relaxants are used. Many of the patients who require VAD(s) implantation have impaired renal function and in these cases cisatracurium besylate is used. If renal function is preserved then rocuronium bromide (0.05 mg/kg) or vecuronium bromide is acceptable.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Among opioids, the potent synthetic drug "fentanyl citrate" is particularly suitable for transdermal administration, and its utility in pain therapy has been extensively evaluated. Transdermal fentanyl systems (TTS) are available in four release programs of 25,50,75, and 100μg/ hour, depending on the patch size, and the drug is released continuously for 3 days. A substantial amount of fentanyl remains in used systems even after 3 days of application [109]. When a TTS is removed, fentanyl continues to be absorbed into the systemic circulation from the cutaneous depot. However, opioid withdrawal symptoms may occur after discontinuation of TTS administration, as well as after conversion from other opioids to TTS [110,111]. Moreover, withdrawal symptoms were reported during chronic TTS administration and were managed with oral methadone [112].
Acute pain management in children
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
After i.v. administration, a single dose of fentanyl has a duration of 30–45 minutes. As fentanyl is highly lipid soluble, its pharmacokinetic profile is context sensitive such that half-life progressively increases with infusion duration.87 It can be given parenterally, neuraxially, intranasally, and by oral transmucosal fentanyl citrate (OTFC) and transdermal techniques, the i.v. preparation has also been given orally where its pharmacokinetics resemble OTFC (see below under Administration and pharmacokinetics).88 Fentanyl can be used for postoperative analgesia and for procedural pain, particularly when morphine is contraindicated. In the epidural space it is used alone or combined with local anaesthetic.89, 90 A disposable iontophoretic transdermal fentanyl PCA system has been developed recently, which may also be suitable for older children.91 OTFC has been used for premedication but highly variable bioavailability, PONV, and prolonged postoperative recovery have limited its popularity.92
The Short-Term Efficacy of Novel No-Touch Combined Directional Perfusion Radiofrequency Ablation in the Treatment of Small Hepatocellular Carcinoma with Cirrhosis
Published in Journal of Investigative Surgery, 2022
Chengming Qu, Xin-Qian Li, Changfeng Li, Feng Xia, Kai Feng, Kuansheng Ma
All RFA procedures were performed by a hepatobiliary surgeon with more than 15 years of experience in RFA. All operations were performed under monitoring anesthesia, and puncture was performed percutaneously under the guidance of real-time US. An injection of fentanyl citrate (0.1 – 0.2 mg, Humanwell Pharmaceutical Co., Ltd., Yichang, China) was used for analgesia, an injection of dexmedetomidine hydrochloride (50 – 100 mg, Hengrui Medicine Co., Ltd., Jiangsu, China) was administered for sedation, and an injection of lidocaine hydrochloride (Zhaohui Pharmaceutical Co., Ltd., Shanghai, China) was used for topical anesthesia. The number of RF electrodes used depended on the diameter of the tumor. For tumors with a diameter of ≤ 20 mm, two electrodes were used; for tumors with a diameter between 20 and 30 mm, three electrodes were used. Preoperative contrast-enhanced US was performed to identify the tumor site. The optimal treatment position and needle insertion route (selected to avoid large blood vessels, bile ducts and adjacent organs) were selected, and the puncture point was marked on the skin.
Percutaneous ultrasound-guided ‘three-step’ radiofrequency ablation for giant hepatic hemangioma (5–15 cm): a safe and effective new technique
Published in International Journal of Hyperthermia, 2020
Chengming Qu, Hui Liu, Xin-Qian Li, Kai Feng, Kuansheng Ma
All RFA procedures were performed by a hepatobiliary surgeon with more than 15 years of experience in RFA. All operations were performed under monitoring anesthesia, and puncture was performed percutaneously under the guidance of real-time ultrasound. An injection of fentanyl citrate (0.1–0.2 mg, Humanwell Pharmaceutical Co., Ltd., Yichang, China) was used for analgesia, an injection of dexmedetomidine hydrochloride (50–100 mg, Hengrui Medicine Co., Ltd., Jiangsu, China) was administered for sedation, and an injection of lidocaine hydrochloride (Zhaohui Pharmaceutical Co., Ltd., Shanghai, China) was used for topical anesthesia. All ablations were performed using an RF electrode with a suction function (LDDJSl-0200200, Mianyang Lide Electronics Co., Ltd., Mianyang, China) and a multipole RF ablation system (LDRF-120S, Mianyang Lide Electronics Co., Ltd., Mianyang, China). The number of RF electrodes depends on the diameter of the tumor. For tumors with a diameter of <10 cm, one or two electrodes were used: for tumors with a diameter between 10 and 15 cm and three electrodes were used. Preoperative contrast-enhanced ultrasound was performed to identify the tumor site and tumor-feeding artery (Figure 2(A)). The optimal treatment position and needle insertion route (selected to avoid large blood vessels, bile ducts and adjacent organs) were selected, and the puncture point was marked on the skin.
Trends in Prehospital Analgesia Administration by US Forces From 2007 Through 2016
Published in Prehospital Emergency Care, 2019
Steven G. Schauer, Jason F. Naylor, Joseph K. Maddry, Carmen Hinojosa-Laborde, Michael D. April
Throughout the course of these wars, the recommendations further changed with the addition of oral transmucosal fentanyl citrate (OTFC, “fentanyl lollipop”) in 2006 and ketamine (via all routes: intravenous, intramuscular, intranasal, intraosseous) in 2012 (8). OTFC is simple to administer without the need for vascular access, provides effective analgesia, and appears safe for use in the battlefield setting (9, 10). Ketamine similarly provides effective analgesia, has an excellent hemodynamic profile, and has a high therapeutic index (11–13). The impact of these changes in the TCCC guidelines on patterns of prehospital battlefield analgesic administration remains unclear.