Navegando por Palavras-chave "fentanyl"

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    Opioid and Benzodiazepine Withdrawal Syndrome in PICU Patients: Which Risk Factors Matter?
    (Lippincott Williams & Wilkins, 2016) Lucas da Silva, Paulo Sergio; Reis, Maria Eunice; Machado Fonseca, Thais Suelotto; Machado Fonseca, Marcelo Cunio [UNIFESP]
    Background and Aims:Although iatrogenic withdrawal syndrome (IWS) has been recognized in patients exposed to opioids and benzodiazepines, very few studies have used a validated tool for diagnosis and assessment of IWS in critically ill children. We sought to determine IWS rate, risk factors, and outcomes of IWS patients.Methods:Prospective observational study conducted in a pediatric intensive care unit. A total of 137 patients (31 with IWS and 106 with no IWS) received a continuous infusion of fentanyl and midazolam for 3 or more days. The Sophia Observation withdrawal Symptoms scale was repeatedly applied when children were weaned off sedation/analgesia.Results:The overall incidence of IWS was 22.6%. Of the 31 IWS patients, 6 showed IWS with less than 5 days sedation or analgesia. Logistic regression showed that the median peak dose of midazolam was associated with IWS development (odds ratio 1.4). Receiver-operating curve showed a cut-off value of 0.35mg/kg/h for midazolam peak dose (sensitivity 96.7%, specificity 51%, positive predictive value 36.6%, and negative predictive value 98.2%), with area under the curve of 0.80. IWS patients had a longer time on mechanical ventilation, prolonged pediatric intensive care unit, and hospital stays, and required prolonged period to have drugs discontinued.Conclusions:Although length of sedation/analgesia for at least5 days has been widely proposed for monitoring IWS, our data suggest that initiating monitoring after 3 sedation days is highly recommended. In addition, patients requiring infusion rates of midazolam above 0.35mg/kg/h should be considered at high risk for IWS.
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    Pro-epileptic effect of alfentanil in rats subjected to pilocarpine-induced chronic epilepsy
    (Elsevier B.V., 2006-05-15) Garrido Sanabria, Emilio Rafael; D'Andrea Vieira, Isabella; Fernanda Da Silveira Pereira, Maria; Coutinho Faria, Leonardo; Da Silva, Andre Cesar; Abrao Cavalheiro, Esper; Silva Fernandes, Maria Jose da; Universidade Federal de São Paulo (UNIFESP); Univ Brownsville
    Pharmacological induction of epileptiform activity is a complementary method to study the epileptogenic area in drug-resistant epileptic patients. Among the different activation methods, fentanyl derivatives (e.g. alfentanil) provide one of the most efficient tools in triggering epileptiform abnormalities in surgical candidates. in this study, we tested the pro-epileptic effect of different concentrations of alfentanil in hippocampal slices obtained from control and pilocarpine-treated chronic epileptic rats. the pro-convulsant action of alfentanil was also studied in control and pilocarpine-treated epileptic rats implanted with subdural and hippocampal electrodes for electroencephalographic recordings. in 90% of slices from control animals, application of affentanil (0.1-5 mu M) induced a significant enhancement in amplitude and number of population spikes recorded in the hippocampal CA1 region. in contrast, alfentanil produced a significant reduction in the amplitude of population spikes in slices from pilocarpine-treated epileptic rats. These changes were accompanied by a significant increase in the number of population spikes in the form of epileptiform multispike responses of epileptic slices. Naloxone (20 mu M) antagonized the effect of alfentanil in both control and epileptic slices, reducing the number of population spikes in slices from epileptic rats. in control rats, alfentanil induced epileptiform abnormalities in the hippocampal and cortical electroencephalographic recordings but only at concentrations higher than 200 [mu g/kg (e.g. 350 mu g/kg). Lower doses of affentanil (25 mu g/kg) elicited epileptiform abnormalities only in chronic epileptic rats. the potent action of a minimal dose of alfentanil in inducing epileptiform activity suggests an enhancement of the pro-convulsant action of mu-receptor opioids in chronic temporal lobe epilepsy. (c) 2006 Elsevier Inc. All rights reserved.
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    Procedural sedation for insertion of central venous catheters in children: comparison of midazolam/fentanyl with midazolam/ketamine
    (Blackwell Publishing, 2007-04-01) Silva, Paulo Sergio Lucas da; Iglesias, Simone Brasil de Oliveira [UNIFESP]; Aguiar, Vania Euzebio; Carvalho, Werther Brunow de; Universidade Federal de São Paulo (UNIFESP)
    Background: There is a lack of studies evaluating procedural sedation for insertion of central venous catheters (CVC) in pediatric patients in emergency departments or pediatric intensive care units (PICU). This study was designed to evaluate whether there is a difference in the total sedation time for CVC insertion in nonintubated children receiving two sedation regimens.Methods: Patients were prospectively randomized to receive either midazolam/fentanyl (M/F) or midazolam/ketamine (M/K) i.v. the Children's Hospital of Wiscosin Sedation Scale was used to score the sedation level.Results: Fifty seven patients were studied (28 M/F and 29 M/K). Group M/F received midazolam (0.24 +/- 0.11 mg.kg(-1)) and fentanyl (1.68 +/- 0.83 mu g.kg(-1)) and group M/K received midazolam (0.26 +/- 0.09 mg.kg(-1)) and ketamine (1.40 +/- 0.72 mg.kg(-1)). the groups were similar in age, weight, risk classification time and sedation level. Median total sedation times for M/F and M/K were 97 vs 105 min, respectively (P = 0.67). Minor complications occurred in 3.5% (M/F) vs 20.7% (M/K) (P = 0.03). M/F promoted a greater reduction in respiratory rate (P = 0.005).Conclusions: in this study of nonventilated children in PICU undergoing central line placement, M/F and M/K provided a clinically comparable total sedation time. However, the M/K sedation regimen was associated with a higher rate of minor complications. A longer period of study is required to assess the efficacy and safety of these sedative agents for PICU procedures in nonintubated children.