High-dose fentanyl for rapid induction of anaesthesia in patients with coronary artery disease

Murkin, John M.; Moldenhauer, C. Craig; Hug, Carl C.

doi:10.1007/bf03011334

Cited by 14 publications

(3 citation statements)

References 15 publications

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“…Traditionally, a variety of fluid regimes have been used around induction of general anaesthesia to ameliorate these combined effects of pre-operative fluid deficit, vasodilation and the cardiovascular depressant actions of anaesthetic drugs [12,13]. This study was designed to investigate the effect of a pre-operative infusion of crystalloid solution (to allow for the patients' maintenance requirements overnight, calculated as 1.5 ml.kg )1 .h )1 ) on pre-operative haemodynamic data, global oxygenation parameters and splanchnic perfusion.…”

mentioning

confidence: 99%

The effect of a pre‐operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting

Klein¹,

Osmer

Müller

et al. 2002

Anaesthesia

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SummarySurgical patients develop a fluid deficit during pre-operative starvation. This study examines the effects of pre-operative fluid administration on haemodynamic variables, oxygenation and splanchnic perfusion in patients undergoing elective coronary artery bypass grafting. Forty-eight patients were randomised to receive either a pre-operative crystalloid infusion (crystalloid group, n ¼ 24) or no infusion (control group, n ¼ 24). Patients in the crystalloid group received a continuous infusion of Ringer's solution at 1.5 ml.kg )1 .h )1 from 22:00 h until induction of anaesthesia the next morning. Immediately before induction of anaesthesia, all patients were given a colloid infusion to increase pulmonary capillary wedge pressure and central venous pressure to similar levels in both groups. Haemodynamic and oxygenation parameters were measured using invasive cardiovascular monitoring, and splanchnic perfusion was assessed by indocyanine green clearance. Patients in the crystalloid group received a mean (SD) of 1008 (140) ml of Ringer's solution overnight. Patients in the crystalloid group had a higher splanchnic blood flow than the control group before induction of anaesthesia [mean (SD) ¼ 1782 (573) ml.min )1 vs. 1391 (333) ml.min )1 , p < 0.05]. There were no significant differences in systemic haemodynamic data and global oxygenation parameters between the two groups. Pre-operative infusion of crystalloid appears to result in an improvement in pre-operative splanchnic perfusion.

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mentioning

confidence: 99%

The effect of a pre‐operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting

Klein¹,

Osmer

Müller

et al. 2002

Anaesthesia

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“…The range of dosing studied is extremely large with pre-hospital doses ranging from 1-1.5 mcg/kg, 30,37 ED dosing of 5 mcg/kg, 22 and OR dosing ranging from 1 mcg/kg as a combination agent and up to 50 mcg/kg when being used as the sole induction agent. 27,38 Such wide dosing variability in published literature makes it difficult to determine the optimal dose for RSI.…”

Section: Discussionmentioning

confidence: 99%

“…In a small study of 9 patients undergoing elective CABG surgery, patients were administered high dose fentanyl (50 mcg/kg) as the primary induction agent. 27 All patients received pancuronium as the primary neuromuscular blocking agent. In all patients, loss of consciousness occurred within 45 seconds following fentanyl administration.…”

Section: Fentanyl In the Operating Roommentioning

confidence: 99%

Rapid Sequence Intubation, is it Time to Find an Alternative Induction Agent? A Narrative Review

Faine,

Carroll,

Sharma

et al. 2023

Journal of Pharmacy Practice

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Objective To review the efficacy, safety, and place in therapy of fentanyl as an induction agent for rapid sequence intubation (RSI) in critically ill patients. Data Sources A comprehensive search of PubMed, EMBASE, and clinical trial registries (1964-June 2021) was performed utilizing the keywords fentanyl, rapid sequence intubation, intubation, induction, anesthesia, hemodynamics, operating room (OR), and emergency. Study Selection and Data Extraction Only primary literature evaluating fentanyl in combination with a sedative or as the sole induction agent was included in the final analysis. Primary literature included peer-reviewed publications and results posted on ClinicalTrials.gov actively recruiting participants. Data Synthesis Fentanyl has been used for decades as an adjunct, and sole induction agent in the OR. Questions surrounding the use of fentanyl as a sole induction agent include optimal dosing and safety in critically ill patients as evaluation in non-OR settings remain limited. Relevance to Patient Care and Clinical Practice Commonly used induction agents (eg, etomidate and ketamine) are associated with adverse events that may increase risk of morbidity and mortality. Fentanyl, a high-potency opioid could serve as an alternative induction agent for RSI due to its neutral hemodynamic response and fast onset of action. This paper compiles and describes existing data on the use of fentanyl as an induction agent for RSI. Conclusion Fentanyl in combination with sedatives provides optimal intubating conditions with minimal impact on hemodynamic parameters. Future studies should focus on safety and impact of awareness during paralysis before fentanyl can be considered as a sole induction agent.

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Herzchirurgie

Gattiker¹,

Schmid²

1992

Anästhesiologie

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High-dose fentanyl for rapid induction of anaesthesia in patients with coronary artery disease

Cited by 14 publications

References 15 publications

The effect of a pre‐operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting

The effect of a pre‐operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting

Rapid Sequence Intubation, is it Time to Find an Alternative Induction Agent? A Narrative Review

Herzchirurgie

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