Comparison of Fentanyl, Remifentanil, Sufentanil and Alfentanil in Combination with Propofol for General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Respiratory depression in women receiving propofol/esketamine versus propofol/fentanyl for abortion surgery or curettage: a randomized clinical trial

BACKGROUND

A combination of opioids with propofol is a popular approach to non-intubated general anaesthesia; however, this method usually results in higher incidence of respiratory depression. We compared the incidence of esketamine- and fentanyl-induced respiratory depression in women undergoing abortion surgery or curettage under propofol-based non-intubated general anaesthesia.

METHODS

This study included 176 women (aged 18-60 years) scheduled for abortion surgery or curettage. Patients were randomized into the fentanyl or esketamine groups. Patients in the fentanyl group received fentanyl (1 µg/kg) combined with propofol intravenously. Patients in the esketamine group received subanaesthetic doses of esketamine (0.15 mg/kg) combined with propofol intravenously. The primary outcome was the incidence of respiratory depression during anaesthesia. Secondary outcomes included respiratory rate, pulse oximetry, blood pressure, heart rate, propofol dose, duration of surgery, duration of anaesthesia, and adverse events.

RESULTS

The incidence of respiratory depression in the esketamine group was significantly lower than that in the fentanyl group (11% vs. 45%; p < .0001). Propofol administration was lower with esketamine than fentanyl. Respiratory rate, SpO2 and blood pressure were more stable in the esketamine group than in the fentanyl group. The incidences of hypotension, propofol-induced injection pain and chin lifting in the esketamine group were lower than those in the fentanyl group. The incidence of nightmares was higher in the esketamine than in the fentanyl group.

CONCLUSIONS

The incidence of respiratory depression was lower with subanaesthetic doses of esketamine than with fentanyl in women undergoing abortion surgery or curettage under propofol-based non-intubated general anaesthesia.KEY MESSAGESOpioids combined with propofol is a popular method for non-intubated general anaesthesia; however, this method usually results in higher incidence of respiratory depression.At subanaesthetic doses, esketamine provides an analgesic effect by antagonizing the N-methyl-d-aspartate receptor.In this trial, the incidence of respiratory depression was lower with subanaesthetic doses of esketamine than with fentanyl in women undergoing abortion surgery or curettage under propofol-based non-intubated general anaesthesia.

Application of Alfentanil Combined With Dexmedetomidine for Conscious Sedation of Patients During Transesophageal Echocardiography Examination

OBJECTIVES

To investigate the efficacy and safety of combining alfentanil with dexmedetomidine for conscious sedation in outpatients undergoing transesophageal echocardiography (TEE).

DESIGN

Prospective, randomized, double-blind clinical trial.

SETTING

University-affiliated teaching hospital.

PARTICIPANTS

We recruited 80 patients scheduled to undergo transesophageal echocardiography examinations from May 2023 to July 2023.

INTERVENTIONS

Eighty patients were randomly assigned into 2 groups, namely, the alfentanil + dexmedetomidine (AD) group (n = 40) and the oropharyngeal topical anesthesia with dyclonine + midazolam + dexmedetomidine (MD) group (n = 40).

MEASUREMENTS AND MAIN RESULTS

Suppression of the patient's pharyngeal reflexes was assessed, and the hemodynamic parameters, along with the incidence of intraoperative adverse events, were also documented. The primary outcome was the initial sedation success rate, defined as achieving a pharyngeal reflex grade of less than 3, no excessive sedation (Ramsay sedation scores >4), and no serious adverse effects. This rate was significantly higher in the AD group (85%) compared with the MD group (35%) (p < .001). Compared with the MD group (47.5%), the incidence of hypotension in AD group (25.0%) decreased significantly (p < .05). Although the incidence of respiratory depression in AD group (42.5%) was higher than that in MD group (15.0%) (p < .01), no hypoxia and asphyxia occurred in either group. The recovery time of AD group (626.25 ± 295.80) was significantly shorter than that of MD group (768.33 ± 310.43) (p < .05). No serious complications occurred in either group.

CONCLUSIONS

Intravenous alfentanil combined with dexmedetomidine effectively inhibits pharyngeal reflexes and demonstrates a favorable safety profile, with fewer incidents of hypotension but a higher incidence of manageable respiratory depression compared with the MD protocol.

Review of the Interactions Between Anesthetic Agents and Chemotherapeutic Agents in Cancer Cell Lines Studied In Vitro

Cancer remains the second leading cause of death worldwide, second to cardiovascular diseases. A significant number of patients with cancer require surgical interventions, highlighting the need to understand the interactions between popular agents used in general anesthesia and in chemotherapy, to provide safe anesthesia and effective anticancer treatment. Given that, for many clinicians, interactions between these 2 broad groups of drugs are not well known; therefore, this topic requires special attention. We have prepared this overview by presenting the actual findings in this field in order to introduce clinicians to this issue. The article considers commonly used drug groups in anesthesiology, such as intravenous and inhaled anesthetics, benzodiazepines, muscle relaxants, and opioids. Their interactions with commonly used antineoplastic drugs, described so far in the literature, are presented. These occurrences highlight the necessity of careful monitoring and control during perioperative care, to not interfere with chemotherapy targets and to prevent the severity of pharmacological adverse effects. To introduce these complex mechanisms, we prepared this article based on the most recent publications possible, considering the many studies carried out in vitro and in vivo, as well as clinical trials. This review was prepared on the basis of 73 articles published from 1989 to 2024, as well as on the authors' knowledge and clinical experience. This article aims to review the interaction between anesthetics and chemotherapeutic agents, based on clinical studies and studies conducted on in vitro cancer cell lines and in vivo animal models.

A review of recent advances in anesthetic drugs for patients undergoing cardiac surgery

Inducing and maintaining general anesthesia requires a diverse set of medications. Currently, heart surgery anesthetic management does not adhere to any one standard protocol or set of drugs. To ensure steady circulatory function while providing sufficient sedation, anesthetic medications are carefully selected for cardiovascular operations. Among the opioids used most often in cardiac surgery are fentanyl, sufentanil, and remifentanil. As a cardiac anesthesiologist, your key responsibilities will be to maintain your patient's blood pressure (BP) and oxygen levels, reduce the frequency and intensity of ischemia events, and make it easy for them to get off of cardiopulmonary bypass (CPB) and supplemental oxygen fast. Additionally, new knowledge gaps have been identified as a result of developments in cardiac anesthetics, which must be addressed. The goal of the most recent developments in cardiac anesthesia has been to decrease risks and increase accuracy in patient outcomes during cardiac surgeries. Furthermore, new methods and tools are contributing to the evolution of cardiovascular anesthesia toward a more dynamic, patient-centered approach, with an eye on boosting safety, decreasing complications, and facilitating better recovery for patients. New medications and methods have emerged in the field of anesthetic pharmacology, aiming to improve anesthesia management, particularly for patients who have cardiovascular disease. Optimal cardiovascular stability, fewer side effects, and enhanced surgical recovery are achieved by use of these medications. We have reviewed all the different kinds of cardiac anesthetic techniques and medications in this research. We have also examined the many new anesthetic medicines that have been produced and used for individuals with cardiovascular issues. Next, we covered prospects in the realm of cardiovascular anesthesia and novel cardiac anesthetic drugs.

The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration study

PURPOSE

Laryngoscopy and endotracheal intubation are known to increase activity of the sympathetic nervous system, and are usually associated with perioperative hypertension, cardiac arrhythmia, and tachycardia. The aim of this study was to determine the effect-site concentrations of remifentanil to inhibit the tracheal intubation response during etomidate anesthesia in elderly patients.

METHODS

American Society of Anesthesiologists physical status I-III patients aged 65 or older and scheduled for general anesthesia for elective surgery were enrolled in the study. Anesthesia induction was applied with etomidate 0.3 mg/kg, rocuronium 0.6 mg/kg, and target controlled infusion of remifentanil under the Minto pharmacokinetic model. Invasive continuous arterial blood pressure monitoring was used throughout the operation. A positive response was defined if the maximal mean arterial pressure (MAP) or heart rate (HR) within 3 min after tracheal intubation was 20% higher than the baseline value. The Dixon sequential method was used for the test, and the initial effect-site concentrations of remifentanil was 6 ng/ml. The EC50 and EC95 for the suppression of endotracheal intubation response by remifentanil were calculated by the probit method.

RESULTS

The EC50 for inhibiting tracheal intubation response by remifentanil in elderly patients was 6.53 ng/ml (95% CI:6.01-7.05 ng/ml) and EC95 was 8.05 ng/ml (95% CI:7.32-8.78 ng/ml) when combined with etomidate anesthesia. The changes of MAP, HR and BIS in positive group were significantly higher than those of negative group (P < 0.05). There were no episodes of hypoxemia, muscular tremor, chest wall rigidity or choking cough in both groups.

CONCLUSIONS

Target controlled infusion of remifentanil in combination with etomidate is effective preventing hemodynamic instability in elderly patients during the anesthesia induction and endotracheal intubation.

CLINICAL TRIAL REGISTRATION

This article was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn registration number: ChiCTR2300076261, date of registration: 28/09/2023).

Effects of Remifentanil Pretreatment on Sufentanil-induced Cough Suppression During the Induction of General Anesthesia

PURPOSE

The aim of this study was to evaluate the effect of remifentanil pretreatment on sufentanil-induced cough during general anesthesia induction.

DESIGN

This experimental research was conducted as a single-center, randomized, parallel-group trial.

METHODS

A total of 120 patients scheduled for elective surgery were equally randomized into two groups (remifentanil and control). The incidence and severity of coughing in both groups were recorded after sufentanil administration during general anesthesia induction. The mean arterial pressure, heart rate, and pulse oxygen saturation were recorded at T1 (before the injection of remifentanil or normal saline), T2 (1 minute after remifentanil administration), T3 (before intubation), and T4 (1 minute after intubation). Additionally, the incidences of adverse events, including dizziness, nausea, apnea, truncal rigidity, bradycardia, or other adverse effects were also recorded.

FINDINGS

The incidence of sufentanil-induced cough in the remifentanil group was significantly decreased when compared with the control group (5.0% vs 35.0%, respectively; P < .001). No statistical differences were found in mean arterial pressure, heart rate, pulse oxygen saturation, and the incidences of other side effects between the two groups at T1, T2, T3, and T4 (P > .05).

CONCLUSIONS

Pretreatment with remifentanil at a dose of 0.5 mcg/kg can effectively and safely suppress the incidence and severity of sufentanil-induced coughing, providing a reference for medication during general anesthesia induction.

Impact of Intraoperative Opioid Use and a Combined Anesthesia Regimen in Patients Undergoing Radical Prostatectomy for Prostate Cancer in a Single-Center Cohort

Introduction: Higher intraoperative opioid doses may be associated with worse long-term oncological outcomes after radical prostatectomy (RP) for prostate cancer. We aimed to evaluate the impact of higher doses of intraoperative opioids and type of anesthesia on biochemical recurrence (BCR) and mortality after RP in a high-volume tertiary center. Methods: All patients underwent RP at our center between 2015 and 2021. The role of major intraoperative opioid agents, such as sufentanil remifentanil, and morphine milligram equivalents (MMEs), as well as the type of anesthesia [total intravenous anesthesia (TIVA), versus a combination of TIVA and epidural anesthesia, versus solely epidural anesthesia], was assessed in predicting BCR and survival after RP. Results: A total of 1137 patients who had a median age of 66 years (interquartile range: 61-72) were included. Overall, 1062 (93%) patients received TIVA, 37 (3%) received TIVA and epidural anesthesia, and 41 (4%) only epidural anesthesia. At a median follow-up of 431 days (interquartile range: 381-639) from RP, 257 (24%) patients developed a BCR. Accordingly, at a median follow-up of 500 days (interquartile range: 450-750), 33 (2.9%) patients died. The type of anesthesia, as well as the dosage or type of the selected intraoperative opioid agents, did not affect either BCR or long-term overall survival. Conclusions: These findings suggest that intraoperative opioid application during RP has no negative oncological impact in the short and long term in patients with localized prostate cancer. Accordingly, combined TIVA and epidural anesthesia, as well as solely epidural anesthesia were associated with similar short- and long-term outcomes compared to TIVA.

Development and Validation of a Discharge Assessment Scale for Outpatients Undergoing Sedative Anesthesia in the Ambulatory Postanesthesia Care Unit: A Comprehensive Delphi Study

PURPOSE

The purpose of this study was to develop a discharge assessment scale tailored for outpatients undergoing sedative anesthesia treatment in the ambulatory postanesthesia care unit and validate its agreement with the Post-Anesthetic Discharge Scoring System.

DESIGN

The Delphi method.

METHODS

A Delphi survey was conducted with 30 experts focusing on the evaluation of outpatient discharges following treatment under ambulatory anesthesia. Subsequently, a cross-sectional observational study employing convenience sampling selected 2,579 outpatients who had undergone painless ambulatory gastrointestinal endoscopy at a tertiary hospital to analyze the level of agreement with the Post-Anesthesia Discharge Scoring System.

FINDINGS

The study conducted three rounds of expert consultations to create the ambulatory discharge assessment scale. Twenty-five experts from 12 provinces and municipalities in our country were interviewed. The discharge assessment form encompassed five aspects: consciousness level, vital signs, directional stability, mobility, and adverse reactions. According to the scale, if the total score exceeded 9 points, with none of the items scoring 0 points, the ambulatory patient could be discharged from the hospital with the accompaniment of family members. Patients assessed using this newly constructed scale were able to leave the hospital earlier compared to those assessed using the comparative scale. No significant differences were observed in vital signs at the time of discharge or the occurrence of adverse events within 24 hours after the procedure.

CONCLUSIONS

This assessment tool for discharging ambulatory patients after the ambulatory anesthesia from the postanesthesia outpatient care unit can be considered a valuable addition to formalize the discharge process in outpatient services.

Reinforcement learning model for optimizing dexmedetomidine dosing to prevent delirium in critically ill patients

Delirium can result in undesirable outcomes including increased length of stays and mortality in patients admitted to the intensive care unit (ICU). Dexmedetomidine has emerged for delirium prevention in these patients; however, optimal dosing is challenging. A reinforcement learning-based Artificial Intelligence model for Delirium prevention (AID) is proposed to optimize dexmedetomidine dosing. The model was developed and internally validated using 2416 patients (2531 ICU admissions) and externally validated on 270 patients (274 ICU admissions). The estimated performance return of the AID policy was higher than that of the clinicians' policy in both derivation (0.390 95% confidence interval [CI] 0.361 to 0.420 vs. -0.051 95% CI -0.077 to -0.025) and external validation (0.186 95% CI 0.139 to 0.236 vs. -0.436 95% CI -0.474 to -0.402) cohorts. Our finding indicates that AID might support clinicians' decision-making regarding dexmedetomidine dosing to prevent delirium in ICU patients, but further off-policy evaluation is required.

Dopamine D2 receptors in the accumbal core region mediates the effects of fentanyl on sleep-wakefulness

Fentanyl, a potent analgesic and addictive substance, significantly impacts sleep-wakefulness (S-W). Acutely, it promotes wake, whereas chronic abuse leads to severe sleep disruptions, including insomnia, which contributes to opioid use disorders (OUD), a chronic brain disease characterized by compulsive opioid use and harmful consequences. Although the critical association between sleep disruptions and fentanyl addiction is acknowledged, the precise mechanisms through which fentanyl influences sleep remain elusive. Recent studies highlight the role of the dopaminergic system of the nucleus accumbens (NAc) in S-W regulation, but its specific involvement in mediating fentanyl's effects on S-W remains unexplored. We hypothesized that dopamine D2 receptors mediate fentanyl-induced effects on S-W. To test this hypothesis, male C57BL/6J mice, instrumented with sleep recording electrodes and bilateral guide cannulas above the accumbal core region (NAcC), were utilized in this study. At dark onset, animals were bilaterally administered sulpiride (D2 receptors antagonist; 250 ng/side) in the NAcC followed by an intraperitoneal injection of fentanyl (1.2 mg/Kg). S-W was examined for the next 12 h. We found that systemic administration of fentanyl significantly increased wakefulness during the first 6 h of the dark which was followed by a significant increase in NREM and REM sleep during the second 6 h of the dark period. D2-receptor blockade significantly reduced this effect as evidenced by a significant reduction in fentanyl-induced wakefulness during first 6 h of dark period and sleep rebound during the second 6 h. Our findings suggest that D2 receptors in the NAcC plays a vital role in mediating the fentanyl-induced changes in S-W.

Balancing acts: The dual faces of fentanyl in medicine and public health

Fentanyl is a potent synthetic opioid widely used in medicine for its effective analgesic properties, particularly in surgical procedures and in the treatment of severe, chronic pain. In recent decades, however, there has been a worrying increase in the illicit use of fentanyl, particularly in North America. This rise in illicit use is concerning because fentanyl is associated with polydrug abuse, which adds layers of complexity and dangerous. This review provides a comprehensive examination of fentanyl, focusing on its synthesis and medical use. It also discusses the significance of the piperidine ring in medicinal chemistry as well as the critical role of fentanyl in pain management and anesthesia. Furthermore, it addresses the challenges associated with the abuse potential of fentanyl and the resulting public health concerns. The study aims to strike a balance between the clinical benefits and risks of fentanyl by advocating for innovative uses while addressing public health issues. It examines the chemistry, pharmacokinetics and pharmacodynamics of fentanyl and highlights the importance of personalized medicine in the administration of opioids. The review underscores the necessity of continuous research and adaptation in both clinical use and public health strategies.

How 3D printing technologies could undermine law enforcement strategies targeting the production and distribution of designer drugs

Countering the supply of counterfeit and designer drug pills laced with fentanyl or its analogues has long been a challenge with the potency of the drug and the ease with which it can be obtained impacting greatly on families and the wider society. The introduction of legislative measures to restrict access to the machinery that allows the production of the pills has yielded considerable gains with numerous seizures of pill presses reported. However, the increasing availability of bench top milling machines and advances in 3D printing could render this a short term victory where the technology may be set to outpace the capabilities of conventional law enforcement. While pill presses were once born from high specification industrial machining, low cost mills and 3D printing systems are already at the stage of producing small format presses within the domestic home. Here, a spotlight is trained on fentanyl (and its analogues) from the perspective of pill manufacture and their supply. An overview of pill press mechanics and the approaches presently taken to counter distribution is provided and the potential influence that both milling systems and 3D printing technologies could have in the future is critically evaluated.

Efficacy and safety of a generic remifentanil formulation versus fentanyl and Ultiva during general anaesthesia: A phase III, prospective, multi-centric, observer-blind, randomised controlled trial

Background and Aims

Remifentanil and fentanyl are potent opioid analgesics commonly used during surgery due to their distinct pharmacological profiles. This study aimed to compare the efficacy and safety of a generic remifentanil (test drug) with fentanyl and Ultiva (innovator formulation) during general anaesthesia in the Indian population.

Methods

This phase III, multi-centre (n = 13), randomised, three-arm, comparative study was conducted from 24 November 2021 to 31 March 2022. Eligible subjects scheduled for elective therapeutic and diagnostic surgical procedures (n = 314) were randomised into generic remifentanil, Ultiva, and fentanyl groups. An independent anaesthetist blinded to treatment allocation assessed efficacy and safety parameters. The primary efficacy endpoint was haemodynamic response during specific activities (endotracheal intubation, skin incision, skin closure, and extubation).

Results

The study groups exhibited no significant differences in demographic and baseline characteristics. Heart rate was similar between the remifentanil and Ultiva groups measured during laryngeal intubation, skin incision, skin closure, and extubation (P > 0.05 in all four procedures). Heart rate was significantly higher in the fentanyl group in comparison to the remifentanil group during laryngeal intubation (P = 0.035), skin incision (P = 0.017), skin closure (P = 0.001), and extubation (P = 0.026). The need for vasopressor and anti-cholinergic drugs was similar between groups, and no subject required naloxone administration.

Conclusion

Our study's findings demonstrated that generic remifentanil is non-inferior to fentanyl and equivalent to Ultiva for general anaesthesia in Indian patients undergoing various surgical and diagnostic procedures. Remifentanil offers advantages in terms of optimum haemodynamic stability, fast equilibrating analgesia, and rapid emergence from sedation, making it a suitable alternative to fentanyl.

ED50 of ciprofol combined with different doses of remifentanil during upper gastrointestinal endoscopy in school-aged children: a prospective dose-finding study using an up-and-down sequential allocation method

Objective

This study aimed to determine the 50% effective dose (ED50) of ciprofol when combined with different doses of remifentanil for upper gastrointestinal endoscopy of school-age children and to evaluate its safety.

Methods

This study involved school-aged children who were scheduled to undergo upper gastrointestinal endoscopy under deep sedation. The children were randomly assigned to two groups: remifentanil 0.3 μg/kg (R0.3) and remifentanil 0.5 μg/kg (R0.5). Anesthesia was induced with remifentanil, followed by ciprofol. The dose of ciprofol for each patient was determined using the Dixon up-down sequential method. If the MOAA/S score was ≤1 and the child did not exhibit significant movement or coughing during the endoscopy process, sedation was considered successful. The first patient in each group received 0.5 mg/kg ciprofol. The dose of ciprofol was adjusted by 0.05 mg/kg based on the response of the previous patient. The primary outcome was the ED50 of the ciprofol-induction dose. The total ciprofol doses, onset times, awakening times, and adverse reactions were recorded.

Results

1) The Dixon method was used to collect crossovers data from each group, and the ED50 values of the R0.3 and R0.5 groups were calculated to be 0.390 mg/kg (95% CI 0.356-0.424 mg/kg) and 0.332 mg/kg (95% CI 0.291-0.374 mg/kg), respectively. The ED50 of ciprofol in the R0.3 group was significantly higher than that in the R0.5 group (p < 0.05). 2) The onset time and recovery time of the R0.5 group were shorter than those of the R0.3 group (p < 0.05). When the two groups were compared, the total dose of ciprofol in the R0.5 group decreased (p < 0.05). 3) Compared with the R0.3 group, the incidence of respiratory depression during induction in the R0.5 group increased (p < 0.05).

Conclusion

This study explored the ED50 of ciprofol combined with different doses of remifentanil for successful sedation in upper gastrointestinal examinations in school-aged children. Compared to the use of remifentanil 0.3 μg/kg, the combination of ciprofol with remifentanil 0.5 μg/kg significantly reduced the ED50 required to prevent body movement or cough during endoscope insertion but increased the incidence of respiratory depression.

Effects of Intraoperative Opioid Use and a Combined Anesthesia Protocol in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder-A Single-Center Experience

BACKGROUND

An increased intraoperative opioid dose seems to lead to worse outcomes in several types of cancer. We assessed the effect of intraoperatively administered opioids as well as the type of anesthesia on survival, recurrence rates and major perioperative outcomes in patients who underwent radical cystectomy (RC) for urothelial carcinoma of the urinary bladder.

METHODS

We included patients who underwent open RC at our center between 2015 and 2022. The role of the type and dosage of intraoperative opioid agents, such as remifentanil, sufentanil and morphine milligram equivalents (MME), as well as the type of anesthesia (intravenous only versus intravenous/epidural), was assessed regarding perioperative and long-term outcomes after RC.

RESULTS

A total of 508 patients with a median age of 73 years (IQR: 64-78) were included. Overall, 92 (18%) patients received intravenous anesthesia, whereas 416 (82%) received combined anesthesia. At a median follow-up of 270 days (IQR: 98-808), 108 (21%) deaths and 106 (21%) recurrences occurred. Combined anesthesia was associated with better survival (HR:0.63, 95% CI: 0.4-0.97, p = 0.037) and lower intensive care unit admission rates (OR: 0.49, 95% CI: 0.31-0.77, p = 0.002) in the univariate analysis (unadjusted). The type and dosage of intraoperative opioid agents did not affect long-term survival and recurrence rates, as well as major perioperative outcomes. Nevertheless, the findings of our study were limited by its single-center, retrospective design.

CONCLUSION

The use of intraoperative opioids was not associated with worse outcomes in our cohort, while the use of additional epidural anesthesia seems to be beneficial in terms of overall survival and intensive care unit admissions. Nevertheless, further research is mandatory to validate the safety of opioids in patients undergoing RC.

Global research on sufentanil use in anesthesiology from 2003 to 2023: a bibliometric analysis

Objective

The application of sufentanil of anesthesiology has become a popular research area. However, literature-based bibliometric analyses on sufentanil are limited. Therefore, this study aimed to review the application of sufentanil in anesthesiology, and evaluate the research status and trends in this field.

Methods

We searched the SCI-Expanded, SSCI, and CPCI-S databases from the Web of Science core collection as data sources for articles published from 1 January2003, to 31 December2023, and bibliometric and VOSviewer software were used to visualize and analyze the literature in terms of authors, journals, countries, institutions, and their collaborative networks, as well as keyword networks.

Results

Our analysis included 1,473 relevant publications on the application of sufentanil in anesthesiology. The overall number of publications is on the rise; the top three countries of study were China, the US and France; the top three universities that published relevant articles were Anhui Medical University, Capital Medical University and Zhejiang University; the largest number of publications focused on Anesthesia and analgesia; At present, the studies in this field mainly focus on the application scope, mode, and advantages; adverse reactions; and combined effects of sufentanil in combination with other drugs. The adverse factors for the use of sufentanil in anesthesiology and ways to improve its safety and efficacy are hot topics of research. Future research should explore the applicability of population and dose utilization, novel drug combinations, non-opioid adjuncts, and technological innovations.

Conclusion

An increasing number of publications indicates that researchers are showing interest in the field of sufentanil use in anesthesiology, and ongoing research is at a relatively mature level. While the international community has established a strong foundation for cooperation, the cooperation among researchers, institutions, and countries needs to be enhanced. Simultaneously, efforts must be made to explore and strengthen personnel cooperation, expand the coverage of funding support, and improve the quality of the literature.

The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial

To observe the effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation on patients undergoing ureteroscopic holmium laser lithotripsy. One hundred and twenty patients who underwent ureteroscopic holmium laser lithotripsy in our hospital were selected and randomly divided into nasopharyngeal airway group (research group) and laryngeal mask group (control group). These patients, respectively, received intravenous anesthesia under nasopharyngeal airway and laryngeal mask-assisted ventilation. The following evaluation indexes were compared and analyzed between the two groups, including anesthetic effect, hemodynamics, stress response, postoperative recovery, adverse reactions, etc. There were no significant differences in Visual Analog Scale, hemodynamics, and stress response between the two groups at each time point (P > 0.05). There were no significant differences in residence time and postoperative recovery time between the two groups (P > 0.05). The difference in airway establishment time between the two groups was statistically significant (P < 0.05), and cases with blood in the research group was significantly lower than those in the control group (P < 0.05). Patient satisfaction in research group was significantly higher than those in the control group (P < 0.05). The clinical effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation in ureteroscopic holmium laser lithotripsy is significant, which helps to stabilize patients' hemodynamics, reduce their stress response and adverse reactions, and improve the satisfaction rate of patient.

Evaluation of the clinical effects of atropine in combination with remifentanil in children undergoing surgery for acute appendicitis

BACKGROUND

Acute appendicitis (AA) is the most common cause of acute abdomen in children. Anesthesia significantly influences the surgical treatment of AA in children, making the scientific and effective selection of anesthetics crucial.

AIM

To assess the clinical effect of atropine (ATR) in combination with remifentanil (REMI) in children undergoing surgery for AA.

METHODS

In total, 108 cases of pediatric AA treated between May 2020 and May 2023 were selected, 58 of which received ATR + REMI [research group (RG)] and 50 who received REMI [control group (CG)]. Comparative analyses were conducted on the time to loss of eyelash reflex, pain resolution time, recovery time from anesthesia, incidence of adverse events (AEs; respiratory depression, hypoxemia, bradycardia, nausea and vomiting, and hypotension), intraoperative responses (head shaking, limb activity, orientation recovery, safe departure time from the operating room), hemodynamic parameters [oxygen saturation (SPO2), mean arterial pressure, heart rate, and respiratory rate], postoperative sedation score (Ramsay score), and pain level [the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale].

RESULTS

Compared with the CG, the RG showed significantly shorter time to loss of eyelash reflex, pain resolution, recovery from anesthesia, and safe departure from the operating room. Furthermore, the incidence rates of overall AEs (head shaking, limb activity, etc.) were lower, and influences on intraoperative hemodynamic parameters and stress response indexes were fewer. The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.

CONCLUSION

ATR + REMI is superior to REMI alone in children undergoing AA surgery, with a lower incidence of AEs, fewer influences on hemodynamics and stress responses, and better post-anesthesia recovery.

Anti-Nociceptive Effect of Sufentanil Polymeric Dissolving Microneedle on Male Mice by Hot Plate Technique

Background

Despite the widespread use of opioids to manage severe pain, its systemic administration results in side effects. Among the subcutaneous and transdermal drug delivery systems developed to deal with adverse effects, microneedles have drawn attention due to their rapid action, high drug bioavailability, and improved permeability. Sufentanil (SUF) is an effective injectable opioid for treating severe pain. In this study, we investigated the analgesic effects of SUF using dissolvable microneedles.

Methods

SUF polymeric dissolvable microneedles were constructed through the mold casting method and characterized by SEM and FTIR analysis. Its mechanical strength was also investigated using a texture analyzer. Fluorescence microscopy was applied in vitro to measure the penetration depth of microneedle arrays. Irritation and microchannel closure time, drug release profile, and hemocompatibility test were conducted for the validation of microneedle efficiency. Hot plate test was also used to investigate the analgesic effect of microneedle in an animal model.

Results

Local administration of SUF via dissolving microneedles had an effective analgesic impact. One hour after administration, there was no significant difference between the subcutaneous and the microneedle groups, and the mechanical properties were within acceptable limits.

Conclusion

Microneedling is an effective strategy in immediate pain relief compared to the traditional methods.

Comparison of the Safety and Efficacy of Remimazolam Besylate versus Dexmedetomidine for Patients Undergoing Fiberoptic Bronchoscopy: A Prospective, Randomized Controlled Trial

Objective

Remimazolam besylate is a novel ultra-short-acting benzodiazepine that is rapidly hydrolyzed to zolpidem propionic acid by tissue lipases. We designed this study to compare the safety and efficacy of remimazolam besylate alfentanil versus dexmedetomidine-alfentanil for fiberoptic bronchoscopy (FB).

Methods

One hundred and twenty patients undergoing FB into this prospective randomized controlled trial were divided into two groups. The anesthesia induction consisted of 6 mg/kg/h of remimazolam besylate in the RA group and 0.5 μg/kg of dexmedetomidine in the DA group. 1-2 mg/kg/h of remimazolam besylate or 0.2-0.7 µg/kg/h of dexmedetomidine were administered to maintain during FB. The lowest oxygen saturation, success rate of FB, hemodynamics, time metrics, bronchoscopy feasibility, drug dose requirements, patient and bronchoscopist satisfaction scores, occurrence of intraoperative awareness, number of patients willing to repeat FB with the same sedation regimen, and occurrence and severity of adverse events.

Results

The lowest oxygen saturation during the FB was significantly higher in the RA group (P = 0.001). Compared with the variables in the DA group, peripheral oxygen saturation, systolic blood pressure, and diastolic blood pressure were significantly lower at T2 and T3 in the RA group (P < 0.05). Heart rates were significantly higher from T2 to T4 in the DA group (P < 0.05). More patients experienced bradycardia in the DA group (P = 0.041). Compared with time metrics in the DA group, the induction time, fully-alert time, and recovery room-leaving time were all significantly shorter in the RA group (P < 0.05). The bronchoscopy feasibility scores in the RA group were significantly lower at T2, whereas they were lower at T3 in the DA group (P < 0.05).

Conclusion

Remimazolam besylate is superior to dexmedetomidine when combined with alfentanil during FB, promoting faster patients' recovery, better operative conditions and respiratory stability with similar rates of occurrence and severity of adverse events.

Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study

Background

Cough is one of the most common complications following intravenous administration of sufentanil during anesthesia induction. The study aimed to investigate the protective effect of alfentanil, afentanyl derivative with short onset time and short duration, in reducing sufentanil-induced cough.

Patients and methods

Eighty patients that scheduled for thyroid surgery under general anesthesia were randomly divided into the alfentanil group and normal saline group, with 40 cases per group. Patients in the alfentanil group received intravenous administration of 2 μg/kg alfentanil prior to sufentanil injection during general anesthesia induction, while the same dose of normal saline was administered in the normal saline group. The outcomes measures included the incidence and severity of cough and common side effects of opioids following the administration of sufentanil during the induction of general anesthesia, intraoperative hemodynamics parameters and major adverse events during anesthesia recovery period.

Results

The incidence of cough within one minute after the injection of sufentanil during anesthesia induction was 40% in the normal saline group, and the pretreatment of alfentanil significantly reduced the incidence of sufentanil-induced cough to 5% (p < 0.05). Correspondingly, the patients in the alfentanil group had decreased severity of sufentanil-induced cough compared with the normal saline group (p < 0.05). No significant differences in the incidences of common side effects of opioids (dizziness, nausea and vomiting, chest tightness and respiratory depression) within one minute after sufentanil injection were found (p > 0.05). Furthermore, there were no significant differences between the two groups in intraoperative hemodynamic parameters, extubation time, or the incidences of emergence agitation, respiratory depression, delayed recovery from anesthesia and postoperative nausea and vomiting during Postanesthesia Care Unit stay (p > 0.05).

Conclusion

Pretreatment with low-dose alfentanil (2 μg/kg) effectively and safely reduced both the incidence and severity of sufentanil-induced cough during anesthesia induction.

Clinical Trial Registration Number

Chinese Clinical Trial Registry (identifier: ChiCTR2300069286).

Comparison of patient-controlled analgesia and sedation (PCAS) with remifentanil and propofol versus total intravenous anesthesia (TIVA) with midazolam, fentanyl, and propofol for colonoscopy

BACKGROUND

Colonoscopy is a commonly performed gastroenterological procedure in patients associated with anxiety and pain. Various approaches have been used to provide sedation and analgesia during colonoscopy, including patient-controlled analgesia and sedation (PCAS). This study aims to evaluate the feasibility and efficiency of PCAS administered with propofol and remifentanil for colonoscopy.

METHODS

This randomized controlled trial was performed in an authorized and approved endoscopy center. A total of 80 outpatients were recruited for the colonoscopy studies. Patients were randomly allocated into PCAS and total intravenous anesthesia (TIVA) groups. In the PCAS group, the dose of 0.1 ml/kg/min of the mixture was injected after an initial bolus of 3 ml mixture (1 ml containing 3 mg of propofol and 10 μg of remifentanil). Each 1 ml of bolus was delivered with a lockout time of 1 min. In the TIVA group, patients were administered fentanyl 1 μg/kg, midazolam 0.02 mg/kg, and propofol (dosage titrated). Cardiorespiratory parameters and auditory evoked response index were continuously monitored during the procedure. The recovery from anesthesia was assessed using the Aldrete scale and the Observer's Assessment of Alertness/Sedation Scale. The Visual Analogue Scale was used to assess the satisfaction of patients and endoscopists.

RESULTS

No statistical differences were observed in the Visual Analogue Scale scores of the patients (9.58 vs 9.50) and the endoscopist (9.43 vs 9.30). A significant decline in the mean arterial blood pressure, heart rate, and auditory evoked response index parameters was recorded in the TIVA group (P < 0.05). The recovery time was significantly shorter in the PCAS group than in the TIVA group (P = 0.00).

CONCLUSION

The combination of remifentanil and propofol could provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery in the PCAS group of patients compared with the TIVA group.

Efficacy and safety of ciprofol versus propofol for anesthesia induction in adult patients received elective surgeries: a meta‑analysis

BACKGROUND

Propofol is use widely used in anesthesia, known for its effectiveness, may lead to cardiopulmonary issues in some patients. Ciprofol has emerged as a possible alternative to propofol because it can achieve comparable effects to propofol while causing fewer adverse events at lower doses. However, no definitive conclusion has been reached yet. This meta-analysis aimed to evaluate the efficacy and safety of ciprofol versus propofol in adult patients undergoing elective surgeries under general anesthesia.

METHODS

We searched PubMed, EMBASE, the Cochrane library, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) to identify potentially eligible randomized controlled trials (RCT) comparing ciprofol with propofol in general anesthesia until September 30, 2023. The efficacy outcomes encompassed induction success rate, time to onset of successful induction, time to disappearance of eyelash reflex, and overall estimate means in Bispectral Index (BIS). Safety outcomes were assessed through time to full alertness, incidence of hypotension, incidence of arrhythmia, and incidence of injection-site pain. Continuous variables were expressed as mean difference (MD) with 95% confidence interval (CI), and dichotomous variables were expressed as risk ratio (RR) with 95% CI. Statistical analyses were performed using RevMan 5.4 and STATA 14.0. The quality of the evidence was rated through the grading of recommendations, assessment, development and evaluation (GRADE) system.

RESULTS

A total of 712 patients from 6 RCTs were analyzed. Meta-analysis suggested that ciprofol was equivalent to propofol in terms of successful induction rate, time to onset of successful induction, time to disappearance of eyelash reflex, time to full alertness, and incidence of arrhythmia, while ciprofol was better than propofol in overall estimated mean in BIS (MD: -3.79, 95% CI: -4.57 to -3.01, p < 0.001), incidence of hypotension (RR: 0.63, 95% CI: 0.42 to 0.94, p = 0.02), and incidence of injection-site pain (RR: 0.26, 95% CI: 0.14 to 0.47, p < 0.001). All results were supported by moderate to high evidence.

CONCLUSIONS

Ciprofol may be a promising alternative to propofol because it facilitates achieving a satisfactory anesthesia depth and results in fewer hypotension and injection-site pain. However, we still recommend conducting more studies with large-scale studies to validate our findings because only limited data were accumulated in this study.

TRIAL REGISTRATION

PROSPERO 2023 CRD42023479767.

Attenuation of intestinal ischemia-reperfusion-injury by anesthetics: a potentially protective effect of anesthetic management in experimental studies

Intestinal ischemia-reperfusion injury (IRI) is a potentially severe clinical syndrome after major surgical procedures. In addition to causing intestinal mucosa injury, intestinal IRI further damages distant organs, causing the severity of the condition in patients. So far, effective therapy for intestinal IRI is still absent, and the survival rate of the patients is low. Previous experimental studies have shown that some anesthetics can alleviate intestinal IRI and protect organs while exerting their pharmacological effects, indicating that reasonable perioperative anesthesia management may provide potential benefits for patients to avoid intestinal IRI. These meaningful findings drive scholars to investigate the mechanism of anesthetics in treating intestinal IRI in-depth to discuss the possible new clinical uses. In the present mini-review, we will introduce the protective effects of different anesthetics in intestinal IRI to help us enrich our knowledge in this area.

The effect of esketamine combined with propofol-induced general anesthesia on cerebral blood flow velocity: a randomized clinical trial

BACKGROUND

Esketamine is increasingly used in clinical anesthesia. The effect of esketamine on the blood flow velocity of the middle cerebral artery has a clinical guiding effect. To investigate the effect of esketamine combined with propofol-induced general anesthesia for endotracheal intubation on the blood flow velocity of middle cerebral artery and hemodynamics during the induction period.

METHODS

The randomized clinical trial included 80 patients aged 20-65 years who would undergo non-intracranial elective surgery under general anesthesia in our hospital from May 2022 to May 2023. The participants were divided into two groups based on anesthesia drugs: sufentanil 0.5μg/kg (group C) or 1.5mg/kg esketamine (group E). The primary outcome was variation value in average cerebral blood velocity. The secondary outcomes included cerebral blood flow velocities (CBFV), blood pressure (BP) and heart rate (HR) at four different time points: before induction of general anesthesia (T0), 1 min after the induction drug injected (T1), before endotracheal intubation (T2), and 1min after endotracheal intubation (T3). The occurrence of hypotension, hypertension, tearing and choking during induction was also documented.

RESULTS

The variation of average CBFV from time T0 to T2(ΔVm1) and the variation from time T3 to T0 (ΔVm2) were not obviously different. The median consumption of intraoperative sufentanil in group C was obviously lower than that in group E. At T1, the mean HR of group E was significantly higher than that of group C. At T2 and T3, the BP and HR of group E were obviously higher than that of group C. At T2, the CBFV in the group E were obviously higher than those in the group C. The incidence of hypotension was significantly reduced in the group E compared with the group C. There were no differences in the other outcomes.

CONCLUSIONS

The induction of esketamine combined with propofol does not increase the blood flow velocity of middle cerebral artery. Esketamine is advantageous in maintaining hemodynamic stability during induction. Furthermore, the administration of esketamine did not result in an increased incidence of adverse effects.

TRIAL REGISTRATION

15/06/2023 clinicaltrials.gov ChiCTR2300072518 https://www.chictr.org.cn/bin/project/edit?pid=176675 .

Effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing resection of rectal carcinoma

BACKGROUND

Rectal carcinoma (RC) treatment primarily involves laparoscopic surgery, which may induce significant hemodynamic changes and weaken immune function. Certain anesthetic approaches using opioid drugs (including remifentanil and sufentanil) pose risks, such as hypotension.

AIM

To determine the effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing RC resection.

METHODS

A total of 211 patients one hundred and four patients with RC treated at the First Affiliated Hospital of Dalian Medical University between November 2018 and November 2022 were retrospectively analyzed. Among them, the remifentanil group included 45 patients receiving remifentanil with propofol anesthesia and the sufentanil group included 59 patients receiving sufentanil with propofol anesthesia. Changes in the hemodynamic index, oxidative stress index, general data, consumption of remifentanil, and use of vasoactive drugs were compared. The incidences of adverse reactions were calculated.

RESULTS

The two groups did not significantly differ in terms of operation, anesthesia, and extubation times (P > 0.05). At 1 min after intubation, the sufentanil group showed a notably higher heart rate, systolic blood pressure (SBP), diastolic blood pressure, and mean arterial pressure (MAP) compared with the remifentanil group (P < 0.05), whereas the sufentanil group showed a notably higher SBP and MAP compared with the remifentanil group at 5 min after pneumoperitoneum (P < 0.05). Thirty minutes after surgery, the remifentanil group showed significantly lower plasma cortisol, noradrenaline, and glucose levels than the sufentanil group (P < 0.001). The remifentanil group consumed significantly less remifentanil than the sufentanil group (P < 0.05), and the adoption frequency of ephedrine was lower in the remifentanil group than that in the sufentanil group (P < 0.05). The incidence of hypotension was notably higher in the sufentanil group than that in the remifentanil group (P < 0.05).

CONCLUSION

Remifentanil combined with propofol can improve hemodynamics and relieve oxidative stress in patients undergoing RC resection.

Propofol combined with alfentanil for general anesthesia in vocal cord polypectomy under suspension laryngoscopy

OBJECTIVE

To investigate the clinical effect of propofol combined with alfentanil in vocal cord polypectomy under suspension laryngoscopy.

METHODS

A total of 308 patients undergoing vocal cord polypectomy under suspension laryngoscopy in the First Affiliated Hospital of Nanchang University were included in this prospective study, and the patients were randomly divided into an observation group and a control group. Patients in the observation group received alfentanil combined with propofol, while those in the control group were anesthetized with sufentanil combined with propofol. The heart rate (HR), mean arterial pressure (MAP), real portfolio project (RPP), and Steward postanesthetic recovery scores were compared between the two groups before anesthesia induction (T0), at intubation (T1), 5 min after intubation (T2), at the time of placing suspension laryngoscopy (T3), 1 min after placing the suspension laryngoscopy (T4), 1 min after extraction of support laryngoscope (T5), and 1 min after extubation (T6). In addition, the propofol dosage and peripheral plasma levels of epinephrine (E) and norepinephrine (NE) were also compared between the groups.

RESULTS

The MAP, HR, and RPP of the patients in the observation group were higher than those in the control group at T1-T5 (all P<0.05), while there was no statistical difference at T0 and T6 (all P>0.05). The Steward postanesthetic recovery scores and the propofol dosage in the observation group were lower than those in the control group. In addition, there was a statistically significant difference in the E and NE levels between the two groups after surgery (P<0.001). There was also an interaction effect between the groups and among the time points (both P<0.001).

CONCLUSION

Alfentanil can reduce the fluctuation of hemodynamics during vocal cord polypectomy under suspension laryngoscopy, and therefore improve anesthesia effect. Simultaneously, the usage of propofol was reduced, as well as the stress levels.

CLINICAL TRIAL NUMBER

ChiCTR2100054186.

Impact of Opioid-Free Anesthesia on Postoperative Quality of Recovery in Patients After Laparoscopic Cholecystectomy-A Randomized Controlled Trial

Purpose

Opioid analgesics may delay discharge and affect postoperative quality of recovery because of their significant adverse effects, such as hyperalgesia, postoperative nausea and vomiting (PONV), shivering and urine retention. We aimed to compare the quality of postoperative recovery (QoR) between patients undergoing laparoscopic cholecystectomy surgeries with opioid-free anesthesia (OFA) and those with opioid-based anesthesia (OA).

Patients and Methods

80 adult patients undergoing laparoscopic cholecystectomy were randomly allocated to an opioid-free anesthesia group (Group OFA) or an opioid-based anesthesia group (Group OA). The primary outcome was the quality of postoperative recovery using QoR-15 scale on postoperative day 1 (POD 1) and 2 (POD 2). The secondary outcomes included the incidence of opioid-related adverse symptoms, perioperative hemodynamic data, duration of post-anesthesia care unit (PACU) stay and duration of extubation, and the incidences of hypotension and bradycardia.

Results

A statistically significant difference in total QoR-15 was observed between the two groups on POD 1 and POD 2 (91.00 (90.00, 92.00) vs 113.00 (108.25, 115.00), 106.00 (104.00, 112.00) vs 133.00 (130.00, 135.00), P < 0.001). The incidence of opioid-related symptoms was significantly different between the two groups on POD 1 (P < 0.05). There were between-group differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T3 (P < 0.001). There was also a significant difference in the incidence of hypotension between the two groups (P = 0.001). However, there were no significant differences in the duration of PACU stay, duration of extubation and the incidence of bradycardia (P > 0.05). There was no difference in heart rate between the two groups at all observed time points, either (P > 0.05).

Conclusion

We concluded that the quality of recovery of patients receiving OFA was superior to those receiving OA after laparoscopic cholecystectomy.

The ED50 and ED95 of esketamine for preventing early postoperative pain in patients undergoing laparoscopic cholecystectomy: a prospective, double-blinded trial

BACKGROUND

This study aims to estimate the safety, efficacy, and median effective dose (ED50) of esketamine for preventing early postoperative pain in patients undergoing laparoscopic cholecystectomy.

METHODS

54 patients undergoing laparoscopic cholecystectomy were prospectively randomized into two groups (group C and group E). Different doses of esketamine were intravenously administered before the skin incision in Group E. The patients in group C received the same dose of saline at the same time. General population characteristics were recorded. The median effective dose (ED50) and 95% effective dose (ED95) were calculated using Dixon's up-and-down method. Hemodynamic parameters were monitored, and pain intensity was assessed using a visual analog scale. We also recorded the condition of anesthesia recovery period and postoperative adverse reactions.

RESULTS

The ED50 of esketamine for preventing early postoperative pain was 0.301 mg/kg (95%CI: 0.265-0.342 mg/kg), and the ED95 was 0.379 mg/kg (95%CI: 0.340-0.618 mg/kg), calculated by probability unit regression. Heart rate (HR) was significantly lower in the esketamine group compared to the control at the skin incision (p < 0.05). The total VAS score at resting was significantly lower in the esketamine group compared to the control group during the awakening period (p < 0.05). There was no significant difference between the two groups regarding the incidence of adverse reactions (p > 0.05).

CONCLUSIONS

In this study, esketamine can prevent early postoperative pain effectively. The ED50 and ED95 of esketamine for controlling early postoperative pain were 0.301 mg/kg and 0.379 mg/kg, respectively.

TRIAL REGISTRATION

ChiCTR2200066663, 13/12/2022.

Anesthetic drug concentrations and placental transfer rate in fetus between term and preterm infants, twins, and singletons

Objective: This study aims to determine the drug concentration of etomidate, remifentanil, and rocuronium bromide for general anesthesia in fetus as well as the placental transport rate between term and preterm delivery, twins, and singleton. Study design: Sixty parturients with 72 fetuses undergoing cesarean section under general anesthesia were included. According to whether the fetus was a twin or premature, parturients were divided into Group I (term singleton), Group II (premature singleton), Group III (term twins), and Group IV (premature twins). The preoperative demographic characteristics and laboratory examination of parturients, hemodynamic indicators, the Apgar score of neonates at 1, 5, and 10 min after delivery and at specific assigned values, umbilical artery blood gas analysis results, neonatal weight, and resuscitative measures were recorded. Anesthetic drug concentrations in maternal arterial (MA), umbilical arterial (UA), and umbilical venous (UV) blood were detected by Ultra Performance Liquid Chromatography Tandem Mass Spectrometry (UPLC-MS/MS). Result: No significant differences were observed in the concentrations of etomidate, remifentanil, and rocuronium bromide in MA, UV, and UA blood, or in the UV/MA and UA/UV ratios between term and preterm infants, twins, and singletons. Moreover, there was no variation in the anesthetic drug concentration among each pair of twins. Additionally, no correlation was found between the neonatal weight and the plasma concentrations of anesthetic drugs in UV and UA blood, except for remifentanil in UA blood. Conclusion: Preterm or twin deliveries do not affect the neonatal concentration of etomidate, remifentanil, and rocuronium bromide used in general anesthesia for cesarean sections. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2100046547.

Total Intravenous Anesthesia Protocol for Decreasing Unacceptable Movements during Cerebral Aneurysm Clipping with Motor-Evoked Potential Monitoring: A Historical Control Study and Meta-Analysis

Injury can occur during intraoperative transcranial motor-evoked potential (MEP) monitoring caused by patient movement related to insufficient neuromuscular blocking agent use. Here, we evaluated the incidence of unacceptable movements in patients undergoing intraoperative MEP monitoring following our anesthetic protocol. We reviewed the anesthesia records of 419 patients who underwent unruptured cerebral aneurysm clipping with intraoperative MEP monitoring. The anesthetic protocol included target-controlled infusion with a fixed effect-site propofol concentration of 3 μg/mL and an adjustable effect-site remifentanil concentration of 10-12 ng/mL. We compared our findings of the intraoperative parameters and incidence of spontaneous movement and respiration with those of published meta-analysis studies. Spontaneous movement and respiration occurred in one (0.2%) patient each. The meta-analysis included six studies. The pooled proportions of spontaneous movement and respiration were 6.9% (95% confidence interval [CI], 1.3-16.5%) and 4.1% (95% CI, 0.5-14.1%), respectively. The proportion of spontaneous movement in our study was significantly lower than that in previous studies (p = 0.013), with no significant difference in spontaneous respiration (p = 0.097). Following our center's anesthesia protocol during cerebral aneurysm clipping resulted in a low incidence of spontaneous respiration and movement, indicating its safety for patients undergoing intraoperative MEP monitoring.

New Perspective for Drug-Drug Interaction in Perioperative Period

In this review, we aim to discuss current information on drug interactions in the perioperative period. During this period, patients receive several drugs that may interact with each other and affect the efficacy and safety of the treatment. There are three types of drug interactions: pharmacodynamic, pharmacokinetic, and pharmaceutical. It is important to recognize that drug interactions may increase the toxicity of the drug or reduce its efficacy, increasing the risk of complications in the perioperative period. This review describes the most commonly used perioperative drugs approved by the FDA and some of the described interactions between them. Thoroughly reviewing a patient's medication list and identifying potential interactions are essential steps in minimizing risks. Additionally, vigilant monitoring of patients during and after surgery plays a pivotal role in early detection of any signs of drug interactions. This article emphasizes the significance of addressing DDIs in the perioperative period to ensure patient well-being and advocates for the implementation of careful monitoring protocols to promptly identify and manage potential interactions.

Effect of propofol combined with different anesthetic drugs on respiratory circulation function and erythrocyte immunity in patients undergoing intestinal endoscopic submucosal dissection

BACKGROUND

Endoscopic submucosal dissection (ESD) is a difficult procedure with disadvantages of long operating time, intraoperative stimulation of sympathetic nerve excitation and postoperative pain, and suppression of immune function.

AIM

To investigate the effect of propofol combined with different anesthesia drugs in patients undergoing intestinal ESD.

METHODS

One hundred and fifty patients who planned to undergo intestinal ESD at our hospital from January 2019 to August 2022 were selected and randomly divided into three groups: A, B, and C, with 50 patients in each group. Group A was given propofol + sufentanil + nalbuphine, group B was given propofol + sufentanil, and group C was given propofol. Mean arterial pressure (MAP) and respiratory and circulatory function (pressure airway, Paw), partial pressure of end-expiratory carbon dioxide (P_ETCO₂), bispectral index (BIS), red blood cell immunity [RBC immunocomplex rosette rate (RBC-ICR), erythrocyte cell membrane C3b receptor rosette rate (RBC-C3bR), and cooperative tumor erythrocyte rosette rate (ATER)], intraoperative and post-operative conditions, and adverse reactions were compared among the groups.

RESULTS

Paw and P_ETCO₂ in group A were significantly lower than those in group B and group C from T1 to T3 (P < 0.05). There was no statistically significant difference in BIS values among the three groups from T0 to T3 (P < 0.05). The amount of propofol used, the number of analgesic pump compressions within 48 h after surgery, and the consumption of analgesic pump drugs were significantly lower in group A than in group B and group C (P < 0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P > 0.05).

CONCLUSION

Propofol combined with sufentanil and nalbuphine can better alleviate respiratory and circulatory function inhibition, improve red cell immunity, and reduce the dosage of analgesic drugs in patients with intestinal ESD, with high safety.

Efficacy and safety comparison of esketamine-propofol with nalbuphine-propofol for upper gastrointestinal endoscopy in children: a multi-center randomized controlled trial

Background and Aims

Anesthetics such as propofol, esketamine and nalbuphine are used during the upper gastrointestinal endoscopy to achieve and maintain the desired sedation level. The aim of the study was to evaluate the effectiveness and safety of propofol-nalbuphine and propofol-esketamine in children.

Methods

A multi-centered study was performed at three tertiary class-A hospitals. Children between 3 and 12 years old undergoing diagnostic painless upper gastrointestinal endoscopy were included and randomly divided into esketamine or nalbuphine group to estimate the primary outcome of successful endoscope insertion. The patients were given esketamine 0.5 mg/kg and propofol 2 mg/kg intravenously in esketamine group, with nalbuphine 0.2 mg/kg and propofol 2 mg/kg in the nalbuphine group. The primary outcome was success rate for the first attempt of endoscope insertion in each group. Secondary outcomes included the safety of both anesthesia regimens and gastroenterologist's satisfaction. We used the Face, Leg, Activity, Cry and Consolability (FLACC) scale to evaluate the level of pain before and during the procedure and the Pediatric Anesthesia Emergence Delirium (PAED) scale to assess the level of agitation and delirium after awakening from anesthesia.

Results

Among 246 patients, 200 were randomly included in the final intention-to-treat analysis, with 100 patients in each group. The success rate for the first attempt of endoscope insertion in the esketamine group was higher than the nalbuphine group (97% vs. 66%; P < 0.01). The heart rate and mean arterial pressure after intraoperative administration in the esketamine group were higher than those in the nalbuphine group, while the delirium incidence during awakening was higher in esketamine group (all P < 0.05).

Conclusion

The success rate for the first attempt of endoscope insertion of children undergoing upper gastrointestinal endoscopy in the esketamine group was higher than the nalbuphine group, propofol-related hemodynamic changes were reduced accordingly, while the incidence of esketamine-related adverse effects could be high.

Clinical Trial Registration

Chinese Clinical Trial Registry: ChiCTR2000040500.

The effects of the administration sequence and the type of hypnotics on the development of remifentanil-induced chest wall rigidity: a randomized controlled trial

BACKGROUND

Research on remifentanil-induced chest wall rigidity is limited. Furthermore, its incidence is unknown, and the clinical factors influencing its development remain unclear. This prospective, double-blind, randomized controlled trial aimed to investigate the effects of the administration sequence of hypnotics and remifentanil as well as the type of hypnotic administered on the development of remifentanil-induced chest wall rigidity.

METHODS

A total of 125 older patients aged [Formula: see text] 65 years, who were scheduled to undergo elective surgery under general anesthesia, were enrolled in this study. Participants were randomly assigned to one of four groups; Thio-Remi, Pro-Remi, Remi-Thio, or Remi-Pro. After confirming the loss of consciousness and achieving a target effect-site concentration of 3 ng/mL remifentanil, the development of remifentanil-induced chest wall rigidity was evaluated.

RESULTS

The incidence of chest wall rigidity was significantly higher in the remifentanil-hypnotic group than in the hypnotic-remifentanil (opposite sequence) group (55.0% vs. 21.7%, P < 0.001). Logistic regression analysis revealed that remifentanil-hypnotic administration was a significant predictor of the development of chest wall rigidity (crude odds ratio 4.42, 95% confidence interval 1.99; 9.81, P < 0.001).

CONCLUSIONS

Pretreatment with hypnotics potentially reduces the development of chest wall rigidity during the induction of balanced anesthesia with remifentanil in older patients.

TRIAL REGISTRATION

This article was registered at WHO International Clinical Trials Registry Platform (Trial number: KCT0006542).

Efficacy and safety of ciprofol vs. propofol for the induction and maintenance of general anaesthesia: A multicentre, single-blind, randomised, parallel-group, phase 3 clinical trial

BACKGROUND

HSK3486 (ciprofol) is a 2,6-disubstituted phenol derivative that acts like propofol as an agonist at the gamma-aminobutyric acid-A (GABA A ) receptor.

OBJECTIVE

To investigate the efficacy and safety of HSK3486 for general anaesthesia induction and maintenance.

DESIGN

A single-blinded, randomised, parallel-group, phase 3 trial.

SETTING

Involving 10 study centres, from November 24, 2020 to January 25, 2021.

PATIENTS

A total of 129 patients undergoing nonemergency, noncardiothoracic, and nonneurosurgical elective surgery.

INTERVENTION

Patients were randomly assigned at a 2:1 ratio into HSK3486 or propofol groups, to receive HSK3486 (0.4 mg kg -1 ) or propofol (2.0 mg kg -1 ) for induction before a maintenance infusion at initial rates of 0.8 and 5.0 mg kg -1 h -1 , and were adjusted to maintain a bispectral index (BIS) of 40-60 until the end of surgery.

MAIN OUTCOME MEASURES

Noninferiority between the drugs was evaluated as the lower limit of the 95% confidence interval (CI) for the between-group difference in the success rate of anesthetic maintenance (primary outcome) >-8%. Secondary outcomes included successful anaesthetic induction, full alertness and spontaneous breathing recovery, time until leaving the postanaesthesia care unit and changes in BIS. Safety profiles were also measured.

RESULTS

Of 129 enrolled patients, 128 completed the trial, with 86 in the HSK3486 group and 42 in the propofol group. The success rate for the maintenance of general anaesthesia was 100% for both groups, and noninferiority of HSK3486 was confirmed (95% CI -4.28% to 8.38%). No significant differences were found between the two groups of patients with regard to secondary outcomes (all P  > 0.05). There appeared to be a comparable incidence of treatment for emergency adverse events (TEAEs) (80.2% vs. 81.0%, P  = 1.000) and drug-related TEAEs (57.0% vs. 64.3%, P  = 0.451) in the HSK3486 and propofol groups.

CONCLUSION

HSK3486 had a noninferior efficacy profile compared to propofol, exhibiting excellent tolerance.

TRIAL REGISTRATION

Clinicaltrials.gov, identifier: NCT04511728.

Efficacy and safety of ciprofol versus propofol for the induction of anesthesia in adult patients: a multicenter phase 2a clinical trial

BACKGROUND

Ciprofol is a novel 2, 6-disubstituted phenolic derivative anesthetic that binds to the gamma-aminobutyric acid-A receptor.

AIM

To determine the equally potent dose of ciprofol compared with propofol as an induction agent for general anesthesia in patients undergoing selective surgery, and to assess its safety.

METHOD

A total of 109 patients undergoing selective non-emergency, non-cardiothoracic or non-neurosurgical surgery requiring tracheal intubation for general anesthesia were enrolled. Ten patients per group were assigned to ciprofol-0.3, 0.4 and 0.5 mg/kg, and propofol-2.0 or 2.5 mg/kg groups, respectively to receive an intravenous bolus dose. An additional 20 patients were enrolled in the ciprofol-0.3, 0.5 or propofol-2.0 mg/kg groups. The primary outcome was the success rate of induction defined as a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) ≤ 1 after the initial bolus dose. The secondary outcomes included the time to reach MOAA/S ≤ 1, the time to loss of the eyelash reflex, the incidences and severity of adverse events (AEs).

RESULTS

The success rates were 100% for all 5 groups. The mean time to MOAA/S ≤ 1 and the time to loss of the eyelash reflex were not different among the 5 groups, regardless of whether a top-up dose was needed. There were no significant differences in the incidences and severity of AEs in the dose ranges investigated of ciprofol vs. propofol.

CONCLUSION

The efficacy and safety of a single bolus dose of ciprofol-0.5 mg/kg for the general anesthesia induction in selective surgery patients was comparable to that of propofol-2.0 mg/kg.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT03698617, retrospectively registered.

Propofol Inhibits Ferroptotic Cell Death Through the Nrf2/Gpx4 Signaling Pathway in the Mouse Model of Cerebral Ischemia-Reperfusion Injury

Ferroptosis is characterized by excessive accumulation of iron and lipid peroxides, which are involved in ischemia, reperfusion-induced organ injury, and stroke. Propofol, an anesthetic agent, has neuroprotective effects due to its potent antioxidant, anti-ischemic, and anti-inflammatory properties. However, the relationship between propofol and ferroptosis is still unclear. In the current study, we elucidated the role of ferroptosis in the neuroprotective effect of propofol in mouse brains subjected to cerebral ischemia reperfusion injury (CIRI). Ferroptosis was confirmed by Western blotting assays, transmission electron microscopy, and glutathione assays. Propofol regulated Nrf2/Gpx4 signaling, enhanced antioxidant potential, inhibited the accumulation of lipid peroxides in CIRI-affected neurons, and significantly reversed CIRI-induced ferroptosis. Additionally, Gpx4 inhibitor RSL3 and Nrf2 inhibitor ML385 attenuated the effects of propofol on antioxidant capacity, lipid peroxidation, and ferroptosis in CIRI-affected neurons. Our data support a protective role of propofol against ferroptosis as a cause of cell death in mice with CIRI. Propofol protected against CIRI-induced ferroptosis partly by regulating the Nrf2/Gpx4 signaling pathway. These findings may contribute to the development of future therapies targeting ferroptosis induced by CIRI.

Sufentanil inhibits the proliferation and epithelial mesenchymal transition of lung cancer cells through Wnt/beta-catenin signaling pathway

Lung cancer is the most common malignancy and leading cause of cancer-related death. Sufentanil is a commonly used opioid anesthetic in clinics. This study aimed to explore the effects of sufentanil on the malignant behavior of lung cancer cells. H460 and H1299 lung cancer cell lines were selected for in vitro experiments. The MTT assay was conducted to detect cell viability. Proliferation ability was determined by colony formation and EdU assays. Transwell assays were performed to measure migration and invasion abilities. Western blotting was used to detect the expression of related proteins. LiCl was used to activate the Wnt/β-catenin signaling pathway. Sufentanil decreased the proliferation, migration, and invasion of H460 and H1299 cells. The protein expression levels of vimentin, N-cadherin, β-catenin, c-Myc, and MMP2 were downregulated, while those of E-cadherin and ZO-1 were upregulated after sufentanil treatment. LiCl treatment reversed the effects of sufentanil on H460 and H1299 cells. Sufentanil inhibited the proliferation, migration, invasion, and epithelial-mesenchymal transition of lung cancer cells by regulating the Wnt/β-catenin signaling pathway.

Comparison of the effects of target-controlled infusion-remifentanil/midazolam and manual fentanyl/midazolam administration on patient parameters in dental procedures

Background

Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times.

Methods

In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups.

Results

Eighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO₂ was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO₂ levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05).

Conclusion

The combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.

Effects of different sedatives/analgesics on stress responses in patients undergoing craniotomy and bone flap decompression

Objective

To explore the effects of sedation and analgesia with dexmedetomidine and other drugs on the stress response in patients with cerebral hemorrhage after craniotomy hematoma removal and bone flap decompression and insertion of an indwelling endotracheal catheter.

Methods

A total of 180 patients with cerebral hemorrhage with consciousness disturbance who underwent emergency surgery were included in this study. They were divided into six groups treated with propofol, dexmedetomidine, lidocaine, sufentanil, dezocine, and remifentanil, respectively. Intravenous medication was given after recovery of spontaneous respiration, and stress responses were compared among the group.

Results

Serum concentrations of norepinephrine, epinephrine, and cortisol and systolic blood pressure were significantly correlated with drug treatment. Serum norepinephrine concentrations differed significantly among the groups, except between the sufentanil and propofol groups. There were significant differences in serum epinephrine concentrations among all groups, and significant differences in serum cortisol concentrations among all groups, except the propofol, dexmedetomidine, and lidocaine groups.

Conclusion

Dexmedetomidine can reduce the stress response in patients with intracerebral hemorrhage undergoing emergency craniotomy and bone flap decompression, and can reduce adverse events from an indwelling endotracheal catheter 3 hours post-operation.

The effects of remifentanil combined with propofol on the oxidative damage and the stress and inflammatory responses in cardiac surgery patients

OBJECTIVE

This paper aims to explore the effects of remifentanil combined with propofol on the stress responses, oxidative damage, and inflammatory responses in cardiac surgery patients.

METHODS

One hundred and four patients who underwent cardiac surgery in our hospital from August 2017 to March 2019, were recruited as the study cohort and divided into control and observation groups. The 50 patients in the control group were anesthetized with fentanyl and propofol, and the 54 patients in the observation group were anesthetized with remifentanil and propofol. The general clinical data were observed and compared between the two groups. At different time points, changes in the oxidative stress response indicators (mean artery pressure (MAP) and heart rate (HR)) and in the cardiac function indexes (left ventricular ejection fraction (LVEF), stroke volume (SV), and cardiac output (CO)) were observed. The inflammatory cytokine levels (high-sensitivity C-reactive protein (hs-CRP), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α)) were analyzed using enzyme-linked immunosorbent assays (ELISA). The patients' postoperative recovery (time to spontaneous respiration, time to opening eyes, extubation time) and their Visual Analogue Scale (VAS) scores were observed. Their pain at half an hour and at 24 hours after the operation were observed, as well as their postoperative adverse reactions.

RESULTS

There were no differences in the general data between the two groups (P>0.05). Compared with the patients in the control group, the patients in the observation group had better oxidative stress levels and better cardiac function indexes (P<0.05), better postoperative inflammatory cytokine levels (P<0.05), better postoperative recovery (P<0.05), lower postoperative pain scores (P<0.05), and a lower total incidence of adverse reactions (P<0.05).

CONCLUSION

Remifentanil combined with propofol can effectively reduce oxidative stress and inflammatory responses in cardiac surgery patients.

Ketorolac tromethamine pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a prospective randomized controlled trial

Background

To observe the effect of pretreatment with ketorolac tromethamine on sufentanil-induced cough in general anesthesia patients.

Methods

A total of 102 patients were screened, and 90 patients were scheduled for elective surgery under general anesthesia. The 90 patients were randomly divided into two groups: the control group (C group) and the observation group (KT group). Five minutes before anesthesia induction, the observation group was given ketorolac tromethamine 0.5 mg/kg intravenously within 3 s, while the control group was given the same amount of normal saline intravenously. All patients were given a sufentanil bolus of 0.5 μg/kg (within 3 s) intravenously. One minute later, propofol 2.5 mg/kg and vecuronium 0.15 mg/kg were injected intravenously, and endotracheal intubation was guided by laryngoscopy. The number of coughs that occurred within 1 min after sufentanil injection was recorded. The mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO₂) were recorded at T0 (immediately before pretreatment), T1 (5 min after pretreatment), T2 (before intubation), T3 (1 min after intubation) and T4 (5 min after intubation). The incidence of adverse reactions, including nausea and vomiting, dizziness, drowsiness, delay of recovery, restlessness in the recovery period, respiratory depression and postoperative incision pain, was analyzed.

Results

Within 1 min after sufentanil injection, the incidence and severity of cough in the KT group was significantly lower than that in the C group (P <  0.05). At T0, T1, T2, T3 and T4, there were no significant differences in MAP, HR and SpO2 between the two groups (P >  0.05). There was no significant difference in the dosage of sufentanil, propofol, remifentanil and vecuronium, the incidence of nausea and vomiting, the delay of recovery, dizziness, drowsiness or respiratory depression between the two groups (P >  0.05). However, the incidence of restlessness and the number of patients with VAS scores > 3 in the KT group were significantly lower than those in the C group (P <  0.05).

Conclusion

Pretreatment with intravenous ketorolac tromethamine can significantly reduce the incidence of sufentanil-induced cough during induction of general anesthesia, which can also significantly reduce postoperative incision pain and restlessness during the recovery period.

Trial registration

Chinese Clinical Trial Registry (registration number# ChiCTR2000030287; date of registration: 27/02/2020).