BACKGROUND: The effect of dexmedetomidine on regional splanchnic blood flow remain unclear. OBJECTIVES: We hypothesized, that there is no difference in regional rectal perianastomotic perfusion and oxygenation when using non-opioid dexmedetomidine-isoflurane anesthesia when compared to fentanyl-isoflurane anesthesia. METHODS: Ten female pigs were randomly divided into two groups (Dexmedetomidine, DEX, Fentanyl, FNT). Analgesia was provided by either dexmedetomidine (0.7-1.0 μg/kg/h) or fentanyl (6-10 μg/kg/h). The model of rectosigmoid resection in pigs was used. Two combined Laser Doppler flowmetry (LDF) and oxymetry probes were fixed on the antimesenterial site of the rectosigmoid, one orally and the second distally to resection zone. At the end of the experiment all animals were woken up and extubated. The healing of the anastomosis was controlled seven days after the operation. RESULTS: All experimental animals were hemodynamically stable throughout the experiment. No anastomotic leakage was detected. All animals survived until the seventh postoperative day. In the DEX group the median of the LDF signal on aboral site at the end of experiment was 35% (23-49%), in FNT group the median of the LDF signal was 19% (12-28%), which was statistically significantly lower (p < 0,05). CONCLUSIONS: This study has shown some protective effects of dexmedetomidine-isoflurane based anesthesia on perianastomotic microcirculation when compared to fentanyl-isoflurane based anesthesia.
- MeSH
- Anastomosis, Surgical methods MeSH
- Anesthesia methods MeSH
- Dexmedetomidine * pharmacology MeSH
- Fentanyl * pharmacology MeSH
- Colorectal Surgery methods MeSH
- Swine MeSH
- Animals MeSH
- Check Tag
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Transmukózní fentanyl je určen k optimálnímu řešení atak průlomových bolestí s rychlým nástupem u onkologických pacientů. Nejčastěji jsou používány sublinguální a bukální tablety. Některé transmukózní fentanyly jsou určeny jak k použití pod jazyk, tak k použití bukálně. Pro některé onkologické pacienty je bukální forma aplikace transmukózního fentanylu jediná možná varianta. Průlomová bolest u onkologických pacientů představuje přechodné zhoršení bolesti u pacientů s dobře kontrolovanou základní bolestí. U většiny pacientů dosahuje průlomová bolest svého maxima během 5 až 15 minut, většinou je obtížně předvídatelná; až 48 % pacientů udává, že záchvat nedokážou nikdy předpovědět.
Transmucosal fentanyl is indicated for the optimal management of breakthrough pain attacks with rapid onset in cancer patients. Sublingual and buccal tablets are most commonly used. Some transmucosal fentanyl products are indicated for both sublingual and buccal use. For some patients, the buccal form of transmucosal fentanyl administration is the only viable option. Breakthrough pain in cancer patients represents a transient worsening of pain in patients with well-controlled baseline pain. In most patients, breakthrough pain reaches its peak within 5-15 minutes and is usually difficult to predict, with up to 48% of patients reporting that they can never predict an attack.
- Keywords
- Fenroo bukální tablety,
- MeSH
- Administration, Buccal MeSH
- Administration, Mucosal MeSH
- Administration, Sublingual MeSH
- Tertiary Care Centers MeSH
- Fentanyl * administration & dosage therapeutic use MeSH
- Humans MeSH
- Cancer Pain drug therapy MeSH
- Breakthrough Pain * drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Adjuvants, Anesthesia pharmacology classification adverse effects therapeutic use MeSH
- Analgesics administration & dosage pharmacology classification adverse effects MeSH
- Administration, Mucosal MeSH
- Fentanyl administration & dosage MeSH
- Dosage Forms MeSH
- Humans MeSH
- Pain Measurement methods MeSH
- Dipyrone pharmacology adverse effects therapeutic use MeSH
- Cancer Pain * drug therapy therapy MeSH
- Analgesics, Opioid administration & dosage classification adverse effects MeSH
- Breakthrough Pain diagnosis drug therapy classification MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Fentanyl therapeutic use MeSH
- Humans MeSH
- Dipyrone therapeutic use MeSH
- Cancer Pain drug therapy MeSH
- Analgesics, Opioid * pharmacology classification therapeutic use MeSH
- Breakthrough Pain * etiology drug therapy MeSH
- Tapentadol therapeutic use MeSH
- Tramadol therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- MeSH
- History, 21st Century MeSH
- Drug Industry history economics MeSH
- Fentanyl history economics adverse effects MeSH
- Motion Pictures MeSH
- Inappropriate Prescribing * history MeSH
- Fraud history MeSH
- Opioid-Related Disorders MeSH
- Malpractice history MeSH
- Check Tag
- History, 21st Century MeSH
- Geographicals
- United States MeSH
OBJECTIVE: To compare changes in oesophageal (T-Oeso) and rectal (T-Rec) temperature in dogs during general anaesthesia and premedicated with fentanyl, medetomidine-fentanyl or acepromazine-fentanyl. STUDY DESIGN: Prospective, randomized, blind clinical study. ANIMALS: A total of 120 healthy dogs, aged 2-10 years and weighing 5-20 kg. METHODS: Dogs were randomly allocated to one of three groups. Animals of F group were premedicated with fentanyl (0.01 mg kg-1), MF group with medetomidine (0.005 mg kg-1) and fentanyl (0.01 mg kg-1) and AF group with acepromazine (0.01 mg kg-1) and fentanyl (0.01 mg kg-1). Anaesthesia was induced with propofol and maintained with isoflurane in oxygen-air mixture. Fentanyl was administered continuously (0.01 mg kg-1 hour-1). The T-Oeso, T-Rec and ambient temperatures were recorded after induction (T0) and subsequently at 10 minute intervals for 60 minutes (T10-T60). Data were analysed using anova or their non-parametric equivalents (p < 0.05). RESULTS: Median T-Oeso was significantly higher in MF group between T0-T20 compared with other groups. Median T-Oeso significantly decreased in F group from 38.0 °C (T0) to 37.4 °C (T30), 37.1 °C (T40), 36.9 °C (T50) and 36.6 °C (T60), in MF group from 38.3 °C (T0) to 37.7 °C (T30), 37.5 °C (T40), 37.2 °C (T50) and 37.1 °C (T60) and in AF group from 37.7 °C (T0) to 37.3 °C (T40), 37.2 °C (T50) and 37.1 °C (T60). The T-Rec significantly decreased in F group from 38.0 °C (T0) to 37.4 °C (T40), 37.2 °C (T50) and 36.9 °C (T60), in MF group from 38.3 °C (T0) to 37.5 °C (T50) and 37.4 °C (T60) and in AF group from 38.2 °C (T0) to 37.6 °C (T40), 37.5 °C (T50) and 37.4 °C (T60). CONCLUSIONS AND CLINICAL RELEVANCE: Premedication with fentanyl, medetomidine-fentanyl or acepromazine-fentanyl in the doses used decreased the T-Oeso and T-Rec. The T-Oeso at the beginning of anaesthesia was higher after premedication with medetomidine-fentanyl. However, this difference was not clinically significant.
- MeSH
- Acepromazine * pharmacology administration & dosage MeSH
- Anesthetics, Intravenous pharmacology administration & dosage MeSH
- Anesthesia, General veterinary MeSH
- Esophagus drug effects MeSH
- Fentanyl * pharmacology administration & dosage MeSH
- Anesthetics, Combined administration & dosage pharmacology MeSH
- Medetomidine * pharmacology administration & dosage MeSH
- Preanesthetic Medication veterinary MeSH
- Prospective Studies MeSH
- Dogs MeSH
- Rectum MeSH
- Body Temperature * drug effects MeSH
- Animals MeSH
- Check Tag
- Male MeSH
- Dogs MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial, Veterinary MeSH
- MeSH
- Abscess surgery diagnosis drug therapy MeSH
- Amputation, Surgical adverse effects MeSH
- Analgesics administration & dosage adverse effects MeSH
- Pain etiology drug therapy MeSH
- Adult MeSH
- Infusions, Spinal MeSH
- Fatal Outcome MeSH
- Fentanyl * administration & dosage adverse effects MeSH
- Cicatrix etiology complications pathology MeSH
- Humans MeSH
- Perineum pathology MeSH
- Substance-Related Disorders etiology MeSH
- Urogenital Neoplasms * diagnosis therapy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Fentanyl administration & dosage MeSH
- Middle Aged MeSH
- Humans MeSH
- Cancer Pain * diagnosis drug therapy pathology MeSH
- Breast Neoplasms complications MeSH
- Breakthrough Pain * diagnosis drug therapy pathology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Administration, Cutaneous MeSH
- Pain drug therapy MeSH
- Buprenorphine administration & dosage adverse effects therapeutic use MeSH
- Fentanyl administration & dosage adverse effects therapeutic use MeSH
- Skin Absorption MeSH
- Humans MeSH
- Pain Management * methods MeSH
- Analgesics, Opioid administration & dosage adverse effects therapeutic use MeSH
- Transdermal Patch adverse effects MeSH
- Check Tag
- Humans MeSH
Průlomová bolest se objevuje i přes dobře kontrolovanou základní bolest u vysokého procenta onkologických pacientů a má významný dopad na kvalitu jejich života. Úskalím léčby průlomové bolesti je často nepředvídatelnost, rychlý nástup a krátké trvání epizod. Transmukózní formy fentanylu představují díky svým farmakologickým vlastnostem účinný způsob managementu této bolesti. Předpokladem úspěšné léčby je správná diagnostika průlomové bolesti, adekvátní terapie základní bolesti a individuální přístup. Článek seznamuje s charakteristikami průlomové bolesti, indikacemi transmukózního fentanylu, konkrétními lékovými formami a praktickými aspekty použití.
Breakthrough pain occurs despite well-controlled background pain in a high percentage of cancer patients and has a significant impact on their quality of life. Challenges of treating breakthrough pain are often its unpredictability, rapid onset, and short duration. Given their pharmacological properties, transmucosal forms of fentanyl represent an effective way of managing this type of pain. A prerequisite for successful treatment is a correct diagnosis of breakthrough pain, adequate therapy of background pain and an individual approach. The article focuses on the characteristics of breakthrough pain, indications of transmucosal fentanyl, specific pharmaceutical forms and practical aspects of its use.
- MeSH
- Administration, Mucosal MeSH
- Fentanyl * administration & dosage pharmacology therapeutic use MeSH
- Humans MeSH
- Pain Management MeSH
- Cancer Pain diagnosis drug therapy MeSH
- Analgesics, Opioid pharmacology classification therapeutic use MeSH
- Breakthrough Pain * diagnosis drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
