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Jiang M, Ji J, Li X, Liu Z. Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia. BMC Anesthesiol 2021; 21:146. [PMID: 33980184 PMCID: PMC8114682 DOI: 10.1186/s12871-021-01350-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. METHODS One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. RESULTS Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). CONCLUSIONS Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) "'retrospectively registered".
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Affiliation(s)
- Menglu Jiang
- Department of Anesthesiology, Wuxi 9th Affiliated Hospital of Soochow University, No. 999 Liangxi Rd, 214062, Wuxi, China
| | - Jiawei Ji
- Department of Anesthesiology, Wuxi 9th Affiliated Hospital of Soochow University, No. 999 Liangxi Rd, 214062, Wuxi, China
| | - Xin Li
- Department of Anesthesiology, Wuxi 9th Affiliated Hospital of Soochow University, No. 999 Liangxi Rd, 214062, Wuxi, China
| | - Zhenqing Liu
- Department of Anesthesiology, Wuxi 9th Affiliated Hospital of Soochow University, No. 999 Liangxi Rd, 214062, Wuxi, China.
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Bao F, Xie Q, Zhang H, Zhu S, Kang X. Feasibility of using oxycodone as the sole opioid for induction and maintenance of general anaesthesia in minor/moderate surgery: a prospective, observational, descriptive study. J Int Med Res 2021; 48:300060520957500. [PMID: 33050766 PMCID: PMC7570800 DOI: 10.1177/0300060520957500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives This study presented the feasibility of oxycodone as the sole opioid for general anaesthesia in minor/moderate surgery. Methods In this prospective, observational, descriptive study, 62 patients were enrolled and received intravenous oxycodone as the sole opioid for the induction and maintenance of general anaesthesia. We observed all of these patients to determine whether oxycodone alone could provide sufficient intraoperative and postoperative analgesia, as well as to record the extubation times and adverse events. Results A total oxycodone dose of 0.316 ± 0.05 mg/kg was used for induction and maintenance of general anaesthesia. The dose could maintain haemodynamic stability during surgery and good postoperative analgesia. Oxycodone caused deep sedation (nine patients had Ramsey sedation scores ≥4), leading to respiratory depression and long stays in the post-anaesthesia care unit (PACU). The extubation time (16.9 ± 6.4 minutes) increased with increasing oxycodone doses. Conclusion Oxycodone can be used as the sole opioid for general anaesthesia in minor/moderate surgery. However, care should be taken because of its deep sedation effect. Trial registration: This study is registered at the Chinese Clinical Trial Registry (www.chictr.org.cn): ChiCTR-opc-16009175
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Affiliation(s)
- Fangping Bao
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.,Department of Anesthesiology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People's Republic of China
| | - Qing Xie
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Honggang Zhang
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Shengmei Zhu
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Xianhui Kang
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
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So KY, Jung KT, Jang BH, Kim SH. Effective dose of intravenous oxycodone depending on sex and age for attenuation of intubation-related hemodynamic responses. Turk J Med Sci 2021; 51:102-110. [PMID: 32777896 PMCID: PMC7991858 DOI: 10.3906/sag-2004-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background/aim Preoperative intravenous oxycodone may help to prevent or attenuate intubation-related hemodynamic responses (IRHRs), but its pharmacokinetics differs according to age and sex. Therefore, we investigated the 95% effective dose (ED95) of intravenous oxycodone for attenuating all IRHRs, depending on the age and sex of the study population. Materials and methods All patients were allocated to one of 6 groups: 1) 20–40 year old males, 2) 41–65yearold males, 3) 66–80 year old males, 4) 20–40 year old females, 5) 41–65yearold females, and 6) 66–80 year old females (groups YM, OM, EM, YF, OF, and EF, respectively). Using Dixon’s up-and-down method, the first patient in each group was slowly injected with intravenous oxycodone (0.1 mg kg-1) 20 min before intubation. The subsequent patient received the next oxycodone dose, which was decreased or increased by 0.01 mg kg-1, depending on the “success” or “failure” of attenuation of all IRHRs to within 20% of the baseline values at 1 min after intubation in the previous patient. After obtaining 8 crossover points, predictive ED95 was estimated with probit regression analysis. Results ED95 varied greatly according to age and sex. ED95was 0.133 mg kg-1, 0.181 mg kg-1, 0.332 mg kg-1, 0.183 mg kg-1, 0.108 mg kg-1, and 0.147 mg kg-1in groups YM, OM, EM, YF, OF, and EF, respectively. Conclusion ED95 is higher in males with increasing age but is ambiguous for females. ED95 is higher in males than in females over 40 years of age but is higher in females than in males under 41 years of age. However, after considering the age and sex of the study population, these results can be used as reference doses for further studies to verify the clinical effects of oxycodone for attenuating all IRHRs.
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Affiliation(s)
- Keum Young So
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Bo Hyun Jang
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea,Department of Medicine, Graduate School of Chosun University, Gwangju, Republic of Korea
| | - Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
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Zhang J, Tu Q, Gan J, Miao S, Zhou Y, Li Q, Zheng C. Preemptive Anti-Stress Response Effects of Oxycodone Versus Sufentanil for Patients Undergoing Cardiac Valve Replacement-A Randomized Controlled Trial. Clin Pharmacol Drug Dev 2019; 9:321-329. [PMID: 31820593 DOI: 10.1002/cpdd.764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022]
Abstract
Patients undergoing cardiac valve replacement may experience cardiovascular adverse events during the preoperative period before anesthesia. The study was to compare the preemptive anti-stress response effects of oxycodone versus sufentanil for patients undergoing cardiac valve replacement. Ninety-four patients were enrolled and assigned to group Oxy, group Suf and group NS. Patients in group Oxy were administrated with oxycodone 0.1 mg/kg, group Suf received sufentanil 0.1 μg/kg and group NS were given equivalent volume of normal saline. The primary outcomes included serum levels of cortisol, norepinephrine, and adrenaline. The secondary outcomes involved bispectral index value and the observer's assessment of awareness/sedation grade, levels of mean arterial pressure, heart rate, and the adverse reactions. Compared to group NS, the serum levels of cortisol at T1 to T5 (P < .05), and levels of norepinephrine and adrenaline at T3 to T5 (P < .05) in group Oxy and Suf were lower. The bispectral index value and observer's assessment of awareness/sedation grade T1 to T2 (P < .05) in group Suf were lower than those in group Oxy and NS. Compared with group NS, the levels of mean arterial pressure and heart rate in group Oxy and Suf at T3 to T5 (P < .05) were lower. The incidence of coughing was significantly higher in group Suf (23.3%), but not in group NS (6.7%), than that in group Oxy (3.3%). The preemptive analgesia of oxycodone may be used to inhibit the stress response, without leading to excessive sedation and respiratory depression, which may also help to stabilize hemodynamics during preoperative period.
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Affiliation(s)
- Jian Zhang
- Department of Anesthesiology, Sichuan Provincial Hospital for Women and Children/Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, China
| | - Qing Tu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianhui Gan
- Department of Anesthesiology, Tangshan People's Hospital, Tangshan, China
| | - Shuai Miao
- Department of Anesthesiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Ying Zhou
- Department of Anesthesiology, the Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China
| | - Qiang Li
- Department of Anesthesiology, the Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China
| | - Chuandong Zheng
- Department of Anesthesiology, the Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China
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Koh GH, Jung KT, So KY, Seo JS, Kim SH. Effect of different doses of intravenous oxycodone and fentanyl on intubation-related hemodynamic responses: A prospective double-blind randomized controlled trial (CONSORT). Medicine (Baltimore) 2019; 98:e15509. [PMID: 31045840 PMCID: PMC6504337 DOI: 10.1097/md.0000000000015509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intubation using direct laryngoscopy is a risky and painful procedure that is associated with undesirable hemodynamic changes such as tachycardia, hypertension, and arrhythmia. Recently, intravenous oxycodone was introduced and used for the control of acute postoperative pain and to attenuate intubation-related hemodynamic responses (IRHRs), but there is insufficient information regarding its proper dosage. We investigated the attenuating effects of different doses of oxycodone and fentanyl on IRHRs. METHODS For calculating oxycodone effective dose (ED95), which attenuated all IRHR changes to less than 20% over baseline values in 95% of male patients at 1 minute after intubation, oxycodone 0.1 mg/kg was injected for the first patient 1 hour before intubation, and the next dose for each subsequent patient was determined by the response of the previous patient using Dixon up-and-down method with an interval of 0.01 mg/kg. After obtaining the predictive oxycodone ED95, 148 patients were randomly allocated to groups receiving normal saline (group C), oxycodone ED95 (group O1), oxycodone 2 × ED95 (group O2), or fentanyl 2 μg/kg (group F). We recorded the incidence of "success" as a less than 20% change from baseline values in all IRHRs 1 minute after intubation. RESULTS The predictive oxycodone ED95 was 0.091 (0.081-0.149) mg/kg. The incidence of "success" was highest in group O2 (75.7%), followed by group O1 (62.2%) and group F (45.9%) with significant differences between the groups (P < .001). The systolic, diastolic, mean arterial pressure, and heart rate were not significantly different among groups after administration of either oxycodone or fentanyl. The percentage hemodynamic changes of the group O2 were significantly lower than those of groups F and O1, but the absolute percentage hemodynamic changes were not significantly different among groups F, O1, and O2. The recalculated oxycodone ED95 with probit analysis (0.269 mg/kg) was needed to prevent any arterial pressure and heart rate changes. CONCLUSIONS Oxycodone 0.182 mg/kg is more effective in attenuating all IRHRs than fentanyl 2 μg/kg with safe hemodynamic changes. Further research is required to determine if the recalculated oxycodone ED95 (0.269 mg/kg) is also effective and hemodynamically safe for preventing all IRHRs.
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Affiliation(s)
- Gi-Ho Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine
| | - Keum Young So
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine
| | - Jong Sik Seo
- Department of Medicine, Graduate School of Chosun University, Gwangju, Republic of Korea
| | - Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine
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Kang XH, Bao FP, Zhang HG, Yu DJ, Ha K, Xie Q, Zhu SM. Gender Affects the Median Effective Dose and 95% Effective Dose of Oxycodone for Blunting the Hemodynamic Response to Tracheal Intubation in Narcotic-Naïve Adult Patients. Chin Med J (Engl) 2018; 131:1958-1963. [PMID: 30082527 PMCID: PMC6085854 DOI: 10.4103/0366-6999.238138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Intravenous (IV) oxycodone has been used at induction to prevent an intubation reaction. The aims of the current study were to calculate the median effective dose (ED50) and the 95% effective dose (ED95) of an IV bolus of oxycodone that blunts the hemodynamic response to tracheal intubation with propofol according to gender and to observe the adverse events of induction-dose oxycodone. Methods Adult patients who required general anesthesia and tracheal intubation were enrolled. Tracheal intubation was performed using unified TD-C-IV video laryngoscopy and an ordinary common endotracheal tube. Dixon's up-and-down method was used to obtain ED50data for women and men separately. The initial dose of oxycodone was 0.2 mg/kg for women and 0.3 mg/kg for men (step size was 0.01 mg/kg). Next, a dose-response curve from the probit analysis was generated to determine the ED50and ED95to blunt the intubation reaction in female and male patients. Adverse events following oxycodone injection were observed for 5 min before propofol injection. Results Sixty-three patients were analyzed, including 29 females and 34 males. According to the probit analysis, the ED50 and ED95of oxycodone required to blunt the intubation reaction in women were 0.254 mg/kg (95% confidence interval [CI], 0.220-0.328 mg/kg) and 0.357 mg/kg (95% CI, 0.297-2.563 mg/kg), respectively. In men, the ED50 and ED95were 0.324 mg/kg (95% CI, 0.274-0.381 mg/kg) and 0.454 mg/kg (95% CI, 0.384-2.862 mg/kg), respectively. Men required 28% more oxycodone than women for induction (P < 0.01). The most common adverse events were dizziness (87.3%), vertigo (66.7%), sedation (74.6%), and respiratory depression (66.7%). Conclusions Oxycodone can be used for induction to prevent intubation reactions. Gender affected the ED50and ED95of oxycodone for blunting the tracheal intubation reaction.
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Affiliation(s)
- Xian-Hui Kang
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| | - Fang-Ping Bao
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| | - Hong-Gang Zhang
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| | - Dan-Jun Yu
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| | - Ke Ha
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003; Department of Anesthesiology, Changxing Hospital of Traditional Chinese Medicine, Changxing County, Huzhou, Zhejiang 313100, China
| | - Qing Xie
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| | - Sheng-Mei Zhu
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
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