BACKGROUND: The use of intravenous opioids in the traumatic pain in pre-hospital care in the Czech Republic is based primarily on the indication of a physician. If the paramedic crew arrives at the site earlier or only on their own, analgesia is given after phone-call consultation with the physician or after his arrival at the site. The objective of this study was to evaluate the safety and efficacy of the indication and administration of sufentanil by paramedics in the treatment of pain in acute trauma adult patients without the physician's control. METHODS: Paramedics underwent voluntarily the simulation training aimed at administering intravenously sufentanil to treat pain in acute trauma in adults without physician's indication. Subsequently, the adverse events and efficacy were monitored for a six-month period and compared in two groups: administration of sufentanil by paramedics without this competence, who further consulted the administration by telephone with physicians (group Consultation) and those with this competence (group Competence). RESULTS: A total number of sufentanil administration in group Consultation was 88 and in group Competence 70. There was no respiratory arrest, bradypnea, or need for oxygen therapy reported in any of the study groups. The incidence of nausea was 3% in both groups - Consultation (n = 3) and in Competence (n = 2). Vomiting was not reported in the Consultation group and in 6% in the Competence group (n = 4). Intravenous antiemetic drugs were used in the Consultation group only in 1% (n = 1) and in the Competence group in 7% of patients (n = 5) (p < 0,05). In both groups there was observed a decrease in the pain numeric rating scale (Consultation: M =-3,2; SD = 1,2 points vs. Competence: M =-3,9; SD = 1,8 points). CONCLUSION: Intravenous administration of sufentanil by properly trained paramedics without consultation with a physician in acute trauma can be considered safe.

• Klíčová slova
• Analgesia, Paramedic, Prehospital care, Simulation, Sufentanil, Trauma,
• MeSH
• bolest farmakoterapie   MeSH
• dospělí MeSH
• konziliární vyšetření a konzultace MeSH
• lékaři * MeSH
• lidé MeSH
• opioidní analgetika škodlivé účinky   MeSH
• pomocný zdravotnický personál MeSH
• sufentanil * škodlivé účinky   terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• opioidní analgetika MeSH
• sufentanil * MeSH

INTRODUCTION: Sufentanil is a potent synthetic opioid used for analgesia in neonates; however, data concerning drug disposition of sufentanil and dosage regimen are sparse in this population. Therefore, the aim of the study was to explore sufentanil disposition and to propose optimal loading and maintenance doses of sufentanil in ventilated full-term neonates. METHODS: Individual sufentanil pharmacokinetic parameters were calculated based on therapeutic drug monitoring data using a 2-compartmental model. Linear regression models were used to explore the covariates. RESULTS: The median (IQR) central volume of distribution (Vdc) and clearance (CL) for sufentanil were 4.7 (4.1-5.4) L/kg and 0.651 (0.433-0.751) L/h/kg, respectively. Linear regression models showed relationship between Vdc (L) and GA (r2 = 0.3436; p = 0.0452) as well as BW (r2 = 0.4019; p = 0.0268). Median optimal sufentanil LD and MD were 2.13 (95% CI: 1.78-2.48) μg/kg and 0.29 (95% CI: 0.22-0.37) μg/kg/h, respectively. Median daily COMFORT-B (IQR) scores ranged from 6 to 23 while no significant relationship between pharmacokinetic parameters and COMFORT-B scores was found. DISCUSSION/CONCLUSION: Body weight and gestational age were found as weak covariates for sufentanil distribution, and the dosage regimen was developed for a prospective trial.

• Klíčová slova
• Critical care, Dosage regimen, Neonate, Pharmacokinetics, Sufentanil,
• MeSH
• biologické modely * MeSH
• gestační stáří MeSH
• lidé MeSH
• monitorování léčiv metody   MeSH
• novorozenec MeSH
• opioidní analgetika aplikace a dávkování   farmakokinetika   MeSH
• retrospektivní studie MeSH
• sufentanil aplikace a dávkování   farmakokinetika   MeSH
• tělesná hmotnost MeSH
• tkáňová distribuce MeSH
• umělé dýchání * MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• opioidní analgetika MeSH
• sufentanil MeSH

AIMS: Patient-controlled analgesia (PCA) is usually considered a better option for pain management compared to conventional analgesia. The beneficial effect of PCA has been assessed in a number of studies; however, the results are inconsistent. The goal of this study was to compare of patient-controlled epidural analgesia (PCEA) to conventional epidural analgesia after total hip replacement (THR). METHODS: This prospective study was performed at the Department of Anesthesia and Intensive Care Medicine at a tertiary university hospital. After THR, patients were admitted to the intensive care unit (ICU) and randomized to one of two groups (PCEA and non-PCEA). Postoperative pain in the PCEA group was treated using a standardized protocol, while the analgesia in the non-PCEA group was based on physician prescription according to the patient's clinical condition. The total consumption of analgesics, patients' satisfaction, pain intensity, and analgesia-related complications were recorded for 24 h after surgery. RESULTS: The final sample consisted of 111 patients (PCEA group, n=55 and non-PCEA group, n=56). The PCEA group had significantly lower total consumption of analgesic mixtures (0.9±0.3 and 1.3±0.4 mL/kg per day, P<0.001).There was greater patient satisfaction (P<0.001) in the PCEA group. The mean pain intensity over 24 hours postoperatively was similar for both groups (P=0.14). There was no significant difference in rate of analgesia-related complications between the groups (hypotension, P=0.14; bradypnea, P=0.11). CONCLUSION: Compared to conventional epidural analgesia based on physician prescription, PCEA led to less total analgesic consumption and greater patient satisfaction after THR.

• Klíčová slova
• analgesics, drug consumption, epidural analgesia, pain relief, patient-controlled analgesia, total hip replacement,
• MeSH
• epidurální analgezie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření bolesti MeSH
• náhrada kyčelního kloubu škodlivé účinky   MeSH
• opioidní analgetika aplikace a dávkování   MeSH
• pacientem kontrolovaná analgezie * MeSH
• pooperační bolest diagnóza   farmakoterapie   etiologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• spokojenost pacientů MeSH
• sufentanil aplikace a dávkování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• opioidní analgetika MeSH
• sufentanil MeSH

We aimed to evaluate the regulatory effects of propofol on high-dose remifentanil-induced hyperalgesia. A total of 180 patients receiving laparoscopic cholecystectomy were randomly divided into sevoflurane + high-dose remifentanil (SH) group, sevoflurane + low-dose remifentanil (SL) group and propofol + high-dose remifentanil group (PH) group (n=60). After intravenous administration of midazolam, SH and SL groups were induced with sevoflurane and remifentanil, and PH group was induced with propofol and remifentanil. During anesthesia maintenance, SH and SL groups were given 0.3 microg/kg/min and 0.1 microg/kg/min sevoflurane and remifentanil respectively, and PH group was given 0.3 microg/kg/min propofol and remifentanil. The three groups had significantly different awakening time, extubation time and total dose of remifentanil (P<0.001). Compared with SL group, periumbilical mechanical pain thresholds 6 h and 24 h after surgery significantly decreased in SH group (P<0.05), and the visual analog scale (VAS) scores significantly increased 30 min, 2 h and 6 h after surgery (P<0.05). Compared with SH group, periumbilical mechanical thresholds 6 h and 24 h after surgery were significantly higher in PH group (P<0.05), and VAS scores 30 min, 2 h and 6 h after surgery were significantly lower (P<0.05). PH group first used patient-controlled intravenous analgesia pump significantly later than SL group did (P<0.05). The total consumptions of sufentanil in PH and SL groups were significantly lower than that of SH group (P<0.05). The incidence rates of bradycardia and postoperative chill in PH and SH groups were significantly higher than those of SL group (P<0.05). Anesthesia by infusion of high-dose remifentanil plus sevoflurane caused postoperative hyperalgesia which was relieved through intravenous anesthesia with propofol.

• MeSH
• anestetika inhalační farmakologie   MeSH
• anestetika intravenózní farmakologie   MeSH
• cholecystektomie laparoskopická škodlivé účinky   MeSH
• dospělí MeSH
• hyperalgezie chemicky indukované   prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• opioidní analgetika aplikace a dávkování   škodlivé účinky   MeSH
• pooperační bolest prevence a kontrola   MeSH
• propofol farmakologie   MeSH
• remifentanil aplikace a dávkování   škodlivé účinky   MeSH
• sevofluran farmakologie   MeSH
• sufentanil aplikace a dávkování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• anestetika inhalační MeSH
• anestetika intravenózní MeSH
• opioidní analgetika MeSH
• propofol MeSH
• remifentanil MeSH
• sevofluran MeSH
• sufentanil MeSH

BACKGROUND: The Surgical Plethysmographic Index (SPI) and the Analgesia Nociception Index (ANI) have been suggested for the non-invasive intraoperative monitoring of nociception/anti-nociception balance. We aimed to compare patterns of intraoperative use of opioids, postoperative cortisol levels and postoperative pain scores after intraoperative analgesia guided either by ANI, SPI or anesthesiologist's judgment. METHODS: Seventy-two adult ASA I-III patients scheduled for elective neurosurgical spinal procedures were randomized into the ANI group, SPI group and control group. Anesthesia and intraoperative use of opioids (sufentanil boluses based on body weight) were managed according to a strict protocol. The use of sufentanil was targeted to keep ANI value 50-70 in the ANI group, SPI value below individual postinduction baseline value plus 10 points in the SPI group. In the control group, the use of opioids was left at anesthesiologist's discretion. RESULTS: Additional sufentanil boluses were administered earlier in the ANI and SPI groups in comparison to the control group (third dose after 51.8±22.1 vs. 52.7±14.8 vs. 84.5±24.8 min respectively, P=0.001; fourth dose after 61.3±30.1 vs. 57.2±14.1 vs. 120.0±26.2 min, P=0.003, and fifth dose after 78.8±33.7 vs. 74.0±11.6 vs. 146.7±23.2 min respectively, P=0.009). There were no differences in postoperative cortisol levels, time to spontaneous breathing at the end of anesthesia and postoperative pain scores. CONCLUSIONS: Both ANI and SPI guidance significantly modified intraoperative opioid use, but no modification of postoperative cortisol levels and postoperative pain was observed.

• MeSH
• analgezie * MeSH
• dospělí MeSH
• hydrokortison krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• management bolesti * MeSH
• nocicepce * MeSH
• opioidní analgetika terapeutické užití   MeSH
• peroperační monitorování metody   MeSH
• peroperační péče MeSH
• pooperační bolest diagnóza   MeSH
• prospektivní studie MeSH
• senioři MeSH
• sufentanil terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• hydrokortison MeSH
• opioidní analgetika MeSH
• sufentanil MeSH

The aim of this study was to evaluate the association between OPRM1 and ABCB1 polymorphisms on pain relief with epidural sufentanil in 69 patients after rectosigma resection for cancer. The median number of injections (SD) 2.31 (1.36), IQR=1, required by 118AA subjects was significantly lower in comparison with 118AG group 5.25 (3.13), IQR=6.5, (chi(2)=9.75, p=0.001); correspondingly median drug consumption of 1.16 (0.79), IQR=1.083, defined daily doses (DDD) was significantly less in the 118AA group in comparison with 2.14 (1.17), IQR=2.23, DDD in 118AG subjects, (chi(2)=7.00, p=0.008). Opioid-induced adverse effects were observed in 15 % and 33 % of patients in 118AA and 118AG groups, respectively (chi(2)=8.16, p=0.004). The median number of injections (SD) required by women and men was 3.30 (2.16), IQR=2, and 2.80 (1.59), IQR=1, respectively (chi(2)=6.25, p=0.012). Opioid-induced adverse effects were observed in 26 % and 12 % of women and men, respectively (chi(2)=5.49, p=0.011). Heterozygotes of OPRM1 polymorphism and women were more difficult to treat subpopulations that required higher doses of rescue analgesic medication and suffered more adverse effects.

• MeSH
• epidurální analgezie metody   MeSH
• kolorektální nádory chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• management bolesti metody   MeSH
• opioidní analgetika aplikace a dávkování   MeSH
• P-glykoproteiny genetika   MeSH
• polymorfismus genetický fyziologie   MeSH
• pooperační bolest farmakoterapie   MeSH
• prospektivní studie MeSH
• receptory opiátové mu genetika   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sufentanil aplikace a dávkování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• ABCB1 protein, human MeSH Prohlížeč
• opioidní analgetika MeSH
• OPRM1 protein, human MeSH Prohlížeč
• P-glykoproteiny MeSH
• receptory opiátové mu MeSH
• sufentanil MeSH

INTRODUCTION: Sufentanil is a potent analgesic drug used for pain management. A few studies describe the pharmacokinetics of sufentanil in neonates; however, no pharmacokinetic data about sufentanil during extracorporeal membrane oxygenation have been published yet. CASE REPORT: A 1-day-old neonate with moderate hypoxic-ischemic encephalopathy received veno-arterial extracorporeal membrane oxygenation support for refractory respiratory and circulatory failure. Sufentanil plasma concentrations were determined during both extracorporeal membrane oxygenation (n = 14) and non-extracorporeal membrane oxygenation (n = 17) period. Based on these measurements, individual sufentanil pharmacokinetic parameters were calculated. DISCUSSION: We observed increased sufentanil volume of distribution (11.6 vs 5.6 L/kg) and decreased sufentanil clearance (0.535 vs 0.746 L/h/kg) in extracorporeal membrane oxygenation period. The increment of volume of distribution was attributed to ECMO influence, while difference in clearance was probably due to drug interaction. CONCLUSIONS: This is the first description of sufentanil pharmacokinetics in neonate treated with extracorporeal membrane oxygenation. We observed considerably larger volume of distribution during extracorporeal membrane oxygenation period in comparison with non-extracorporeal membrane oxygenation period.

• Klíčová slova
• extracorporeal membrane oxygenation, neonate, pharmacokinetics, sufentanil,
• MeSH
• lidé MeSH
• mimotělní membránová oxygenace škodlivé účinky   metody   MeSH
• novorozenec MeSH
• opioidní analgetika farmakokinetika   terapeutické užití   MeSH
• sufentanil farmakokinetika   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• opioidní analgetika MeSH
• sufentanil MeSH

BACKGROUND: Hypotension after induction of general anesthesia (GAIH) is common in anesthesiology practice and can impact outcomes. METHODS: In this prospective multicenter, cross-sectional, observational study, the hypotension was defined as a decrease in mean arterial pressure of > 30% compared to the first measurement in the operation theatre before general anesthesia (GA) induction. Blood pressure was measured immediately at the time of endotracheal intubation (TETI), at five (T5) and 10 (T10) minutes after. All subjects aged > 18 years undergoing elective non-cardiac surgery under GA were included. The goals were description of GAIH occurrence, the association of GAIH with selected comorbidities, chronic medications, and anesthetics with GAIH, and the type and efficacy of interventions used to correct hypotension. RESULTS: Data from 661 subjects, whose GA was induced with propofol and sufentanil, were analyzed. In 36.5% of subjects, GAIH was observed at ≥ 1 of the assessed time points. GAIH was present in 2.9% subjects at all time points. The probability of GAIH is raising with age, degree of hypertension at time of arrival to theatre and presence of diabetes. The type of volatile anesthetic was not associated with the occurrence of GAIH. The overall efficiency of interventions to correct hypotension was 94.4%. Bolus fluids were the most often used intervention and was 96.4% effective. CONCLUSION: GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.

• Klíčová slova
• Anesthesia induction, General anesthesia, Hypotension, Predictors, Risk factors,
• MeSH
• anestetika intravenózní aplikace a dávkování   škodlivé účinky   MeSH
• arteriální tlak účinky léků   MeSH
• celková anestezie škodlivé účinky   metody   MeSH
• dospělí MeSH
• hypertenze epidemiologie   MeSH
• hypotenze epidemiologie   MeSH
• intratracheální intubace MeSH
• krevní tlak účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření krevního tlaku MeSH
• propofol aplikace a dávkování   farmakologie   MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• sufentanil aplikace a dávkování   farmakologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• anestetika intravenózní MeSH
• propofol MeSH
• sufentanil MeSH

OBJECTIVE: Comparison of incisional and epidural analgesia in the treatment of postoperative pain after cesarean sectio. DESIGN: Prospective cohort study in the period from 2015 to 2016. SETTING: Department of Obstetric and Gynecology, Masaryk University, University Hospital Brno. MATERIAL AND METHODS: The group included 72 patients in the 38th-41st. week of pregnancy. They were divided at the time of indication to the cesarean section (SC) into two groups according to the selected type of analgesia (epidural/incisional). Women with epidural analgesia (EA) received bupivacaine and sufentanil after surgery in the epidural catheter. A second group was patients during general anesthesia SC introduced into the surgical wound IA Painfusor which was continuously administered bupivacaine. The intensity of the patients pain was evaluated on the visual analogue scale (VAS). If the VAS exceeded 4, the dose of the opioid analgesic piritramide (additional dose of DDA analgesic) was administered intravenously. The intensity of pain and the number of DDAs required were evaluated 24 hours after SC. Satisfaction with pain relief, sleep quality, and patient side effects were assessed using a questionnaire. RESULTS: Patients in the EA group (n = 36) evaluated postoperative pain (PB) value of 4.4 ± 1.8 according to VAS, women in group IA (n = 36) reported a PB according to VAS of 4.4 ± 1.3 (p = 0.972). The difference in the number of applied DDA was not statistically significant compared groups (2.3 ± 0.9 EA vs. 2.4 ± 0.9 IA, p = 0.301). By comparing the other parameters evaluated by the questionnaire statistically significant more vertigo cases were found in women with IA (22.2% EA vs. 72.2% IA, p < 0.001). In the other evaluated parameters the differences between the two methods were not statistically significant. CONCLUSION: Epidural and incisional analgesia are comparable methods in the effectiveness of pain management during the first day of the cesarean section. Except for vertigo, both methods were also comparable in terms of the occurrence of undesirable effects.

• Klíčová slova
• Painfusor, cesarean section, epidural analgesia, incisional analgesia, incisional analgesia Painfusor., postoperative analgesia,
• MeSH
• anestetika lokální MeSH
• bupivakain aplikace a dávkování   MeSH
• císařský řez * MeSH
• epidurální analgezie metody   MeSH
• lidé MeSH
• měření bolesti MeSH
• opioidní analgetika aplikace a dávkování   MeSH
• pirinitramid aplikace a dávkování   MeSH
• pooperační bolest farmakoterapie   MeSH
• prospektivní studie MeSH
• sufentanil aplikace a dávkování   MeSH
• těhotenství MeSH
• vizuální analogová stupnice MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• anestetika lokální MeSH
• bupivakain MeSH
• opioidní analgetika MeSH
• pirinitramid MeSH
• sufentanil MeSH

BACKGROUND: Combined infusions of propofol and sufentanil preparations are frequently used in clinical practice to induce anesthesia and analgesia. However, the stability of propofol emulsions can be affected by dilution with another preparation, sometimes leading to particle coalescence and enlargement. Such unwanted effects can lead to fat embolism syndrome after intravenous application. This study describes the physical stability of 5 commercially available propofol preparations mixed with sufentanil citrate solutions. METHODS: Two common markers of emulsion stability were used in this study; namely, the zeta potential and size distribution of the emulsion droplets. Both were measured using dynamic light scattering. The data for the pure propofol preparations and their mixtures with sufentanil citrate solution were compared. RESULTS: The absolute value of zeta potential decreased in 4 of the 5 propofol preparations after they had been mixed with sufentanil citrate. This effect indicates a lowering of repulsive interactions between the emulsion droplets. Although this phenomenon tends to cause agglomeration, none of the studied mixtures displayed a substantial increase in droplet size within 24 hours of blending. However, our long-term stability study revealed the instability of some of the propofol-sufentanil samples. Two of the 5 studied mixtures displayed a continual increase in particle size. The same 2 preparations showed the greatest reductions in the absolute value of zeta potential, thereby confirming the correlation of both measurement methods. The increase in particle size was more distinct in the samples stored at higher temperatures and with higher sufentanil concentrations. CONCLUSIONS: To ensure the microbial stability of an emulsion infusion preparation, clinical regulations require that such preparations should be applied to patients within 12 hours of opening. In this respect, we can confirm that during this period, none of the studied propofol-sufentanil mixtures displayed any physical instability that could lead to particle enlargement; thus, fat embolism should not be a risk after their intravenous application. However, our long-term stability study revealed differences between commercially available preparations containing the same active ingredient; some of the mixtures showed an increase in particle size and polydispersity over a longer period. Although our results should not be generalized beyond the particular propofol-sufentanil preparations and concentrations studied here, they do suggest that, as a general principle, a compatibility study should be performed for any preparation before the first intravenous application to exclude the risk of droplet aggregation.

• MeSH
• anestetika intravenózní aplikace a dávkování   chemie   MeSH
• chemické jevy * MeSH
• fixní kombinace léků MeSH
• intravenózní infuze MeSH
• lidé MeSH
• propofol aplikace a dávkování   chemie   MeSH
• stabilita léku MeSH
• sufentanil aplikace a dávkování   chemie   MeSH
• velikost částic MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• anestetika intravenózní MeSH
• fixní kombinace léků MeSH
• propofol MeSH
• sufentanil MeSH