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Verma N, Dahake JS. Evaluating Sedation Strategies for Magnetic Resonance Imaging: A Comprehensive Review of Intravenous Fentanyl, Butorphanol, and Midazolam in Adult and Pediatric Populations. Cureus 2024; 16:e58593. [PMID: 38770500 PMCID: PMC11102870 DOI: 10.7759/cureus.58593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Magnetic resonance imaging (MRI) is a critical diagnostic tool that often requires patient sedation to ensure optimal image quality and patient comfort, particularly in those with anxiety or an inability to remain still. This comprehensive review examines the efficacy, safety, and practical considerations of three commonly used intravenous sedatives, namely, fentanyl, butorphanol, and midazolam, in adult populations undergoing MRI procedures. This review highlights the pharmacological profiles, advantages, and limitations associated with each sedative agent through a detailed analysis of current literature, clinical guidelines, and practice-based evidence. Fentanyl is noted for its potent analgesic properties and rapid onset of action, making it suitable for painful procedures. Butorphanol, with its unique opioid agonist-antagonist activity, presents an alternative with a balance between analgesia and sedation, potentially offering a safer profile for certain patient populations. Midazolam, widely recognized for its anxiolytic and amnestic effects, remains a staple in managing procedure-related anxiety. The review further discusses patient selection criteria, dosing strategies, and the importance of individualized sedation planning to enhance patient experience and procedural outcomes. Future directions highlight the potential of emerging sedation agents and non-pharmacological approaches to improve patient comfort and compliance. The findings underscore the necessity for healthcare providers to adapt sedation practices to the specific needs of each patient, considering both the clinical context and the inherent characteristics of the sedative agents. This review aims to guide clinicians in selecting the most appropriate sedation strategy for adult patients undergoing MRI, optimizing patient care and diagnostic efficacy.
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Affiliation(s)
- Neeta Verma
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Janhavi S Dahake
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Dong Y, Chang X. Comparison of Five Prophylactically Intravenous Drugs in Preventing Opioid-Induced Cough: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2021; 12:684276. [PMID: 34867314 PMCID: PMC8635493 DOI: 10.3389/fphar.2021.684276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Due to the absence of direct comparisons of different therapeutic drugs in preventing opioid-induced cough (OIC) during the induction of general anesthesia, clinicians often faced difficulties in choosing the optimal drug for these patients. Hence, this network meta-analysis was conducted to solve this problem. Methods: Online databases, including Pubmed, Embase, Web of Science, Cochrane, and Google Scholar, were searched comprehensively to identify eligible randomized controlled trials (RCTs), up to March 15th, 2021. Within a Bayesian framework, network meta-analysis was performed by the “gemtc” version 0.8.2 package of R-3.4.0 software, and a pooled risk ratio (RR) associated with 95% credible interval (CrI) was calculated. Results: A total of 20 RCTs were finally enrolled, and the overall heterogeneity for this study was low to moderate. Traditional pair-wise meta-analysis results indicated that all of the five drugs, namely, lidocaine, ketamine, dezocine, butorphanol, and dexmedetomidine could prevent OIC for four clinical outcomes, compared with the placebo (all p-values < 0.05). Moreover, dezocine had the best effect, compared with that of the other drugs (all p-values < 0.05). Network meta-analysis results suggested that the top three rank probabilities for four clinical outcomes from best to worst were dezocine, butorphanol, and ketamine based on individual/cumulative rank plots and surface under the cumulative ranking curve (SUCRA) probabilities. The node-splitting method indicated the consistency of the direct and indirect evidence. Conclusions: Our results indicated that all of these five drugs could prevent OIC compared with the placebo. Moreover, the top three rank probabilities for four clinical outcomes from best to worst were dezocine, butorphanol, and ketamine. Our results were anticipated to provide references for guiding clinical research, and further high-quality RCTs were required to verify our findings. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021243358].
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Affiliation(s)
- Yunxia Dong
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaohan Chang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Zhao X, Wang H, Wang HJ, Wang Y, Xing YA, Li ST, Chen LH. Risk Factors for Fentanyl-Induced Cough Following General Anesthesia in Adults: A Retrospective Study from a Single Center in China. Med Sci Monit 2021; 27:e930369. [PMID: 34253706 PMCID: PMC8285987 DOI: 10.12659/msm.930369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Fentanyl-induced cough (FIC) during general anesthesia induction and postoperative nausea and vomiting are common complications, yet the risk factors for FIC remain controversial. This retrospective study was conducted at a single center in China and aimed to investigate the risk factors for fentanyl-induced cough following general anesthesia in adults. Material/Methods A total of 601 adult patients undergoing elective surgery were enrolled, and the incidence of FIC during general anesthesia induction and postoperative adverse events were recorded. The risk factors for FIC during general anesthesia induction and postoperative nausea and vomiting were assessed using multivariate logistic regression analysis. Results The incidence of FIC, nausea, and vomiting were 21.8%, 6.3%, and 4.5%, respectively. The results of multivariate logistic regression analysis indicated that pharyngitis history was associated with an increased risk of FIC during general anesthesia induction (odds ratio [OR]: 2.852; 95% confidence interval [CI]: 1.698–4.792; P<0.001), whereas use of lidocaine could protect against FIC risk (OR: 0.649; 95% CI: 0.557–0.757; P<0.001). However, the characteristics of patients were not associated with the risk of postoperative nausea and vomiting. Conclusions The findings from this study showed that a history of pharyngitis increased the risk of FIC, while the use of lidocaine was associated with a reduced risk of FIC. The risk of postoperative nausea and vomiting was not affected by fentanyl use or patient characteristics.
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Affiliation(s)
- Xiao Zhao
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Hong Wang
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Hui-Juan Wang
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Yun Wang
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Yi-An Xing
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Shi-Tong Li
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Lian-Hua Chen
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
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Butorphanol in combination with dexmedetomidine provides efficient pain management in adult burn patients. Burns 2021; 47:1594-1601. [PMID: 33958243 DOI: 10.1016/j.burns.2020.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aimed to compare the sedation and analgesic effects of butorphanol alone and butorphanol in combination with dexmedetomidine on dressing changes in adult burn patients. METHOD From June 2016 to May 2019, 44 adult burn patients from our department were enrolled in this prospective, double-blinded study. Their total burn surface area (TBSA) varied from 10% to 30%; and the depth of burn injury ranged from second degree to third degree. The patients were randomized into two groups. In the control group, butorphanol combined with saline was injected into the body via venous route during dressing change. In the observation group, butorphanol in combination with dexmedetomidine was injected. The variation in mean blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded at various time-points of the procedure. Visual Analogue Scale (VAS) of pain and Ramsay Sedation Scores (RSS) were also recorded at different time points. Consumption of butorphanol and adverse events in these two groups were compared. RESULTS The mean blood pressure and heart rate were significantly decreased in the observation group before butorphanol injection (P < 0.05) and before the dressing change (P < 0.05). The respiratory rates and peripheral oxygen saturation of these two groups showed no significant differences at all time points (P > 0.05). Patients in the observation group had lower VAS scores during dressing change (P < 0.05). The RSS Scores in the observation group were higher than those in the control group during (P < 0.05) and after the dressing change (P < 0.05). The consumption of butorphanol was more in the control group (P < 0.05), and the adverse events recorded in the control group were higher (P < 0.05). CONCLUSION Butorphanol combined with dexmedetomidine can reduce analgesic use of butorphanol during dressing change. This combination resulted in a higher sedation score and fewer adverse effects.
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Chen R, Tang LH, Sun T, Zeng Z, Zhang YY, Ding K, Meng QT. Mechanism and Management of Fentanyl-Induced Cough. Front Pharmacol 2020; 11:584177. [PMID: 33324214 PMCID: PMC7723435 DOI: 10.3389/fphar.2020.584177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022] Open
Abstract
Fentanyl-induced cough (FIC) often occurs after intravenous bolus administration of fentanyl analogs during induction of general anesthesia and analgesia procedure. The cough is generally benign, but sometimes it causes undesirable side effects, including elevated intra-abdominal, intracranial or intraocular pressure. Therefore, understanding the related mechanisms and influencing factors are of great significance to prevent and treat the cough. This paper reviews the molecular mechanism, influencing factors and preventive administration of FIC, focusing on the efficacy and side effects of various drugs in inhibiting FIC to provide some medical reference for anesthesiologists.
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Affiliation(s)
- Rong Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling-Hua Tang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tao Sun
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zi Zeng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yun-Yan Zhang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Ding
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing-Tao Meng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
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A Small Dose of Butorphanol Prevents Sufentanil-induced Cough During General Anesthesia Induction. J Craniofac Surg 2019; 30:2499-2501. [PMID: 31567764 DOI: 10.1097/scs.0000000000005967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This study aimed to evaluate the suppressive effects of a small dose of butorphanol on sufentanil-induced cough during general anesthesia induction. METHODS 120 patients who were scheduled for elective maxillofacial surgery of American Society of Anesthesiologists I∼II, aged 18∼65 years were randomly divided into 3 groups (n = 40). Patients received butorphanol 0.1 mg (group I), 1 mg (group II) or an equal volume of 0.9% normal saline (group III) 5 seconds right before sufentanil bolus (0.5ug/kg). Sufentanil was diluted into 5ug/mL and administrated within 5 seconds. The incidence and reflex degree of cough in all groups were evaluated within 2 minutes after the injection of sufentanil during anesthesia induction. Mean arterial pressure (MAP) and heart rate (HR) were recorded at T0 (before the injection of butorphanol or normal saline), T1 (before the injection of sufentanil) and T2 (2 minutes after sufentanil injection). RESULTS The HR and MAP values were no significant difference among the 3 groups at the same observation point. In group II, the HR decreased significantly at T2 compared with T0 and T1 (P <0.05, T2 VS T0, T1). None of the patients in group I and group II had cough, and 33 patients in group III developed cough, of which 12.5% were mild, 40% were moderate, and 30% were severe. CONCLUSIONS The results of present study suggest that a small dose of butorphanol 0.1 mg can prevent sufentanil-induced cough and ensure a relatively stable hemodynamic state during general anesthesia induction.
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Zhang J, Miao S, Tu Q, Shi M, Zou L, Liu S, Wang G. Effect of butorphanol on opioid-induced cough: a meta-analysis of randomized controlled trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3263-3268. [PMID: 30323559 PMCID: PMC6173179 DOI: 10.2147/dddt.s180533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to assess the effect of butorphanol on the prevention of opioid-induced cough by a meta-analysis. Materials and methods We searched PubMed, Embase, The Cochrane Library, and the China National Knowledge Infrastructure database for relevant randomized controlled trials (RCTs) to demonstrate the efficacy of butorphanol on the prevention of opioid-induced cough. We used RevMan 5.3 to conduct a meta-analysis on each outcome. Results Eight RCTs comparing 942 patients were included in this study. The pooled meta-analysis showed that the incidence of opioid-induced cough in the butorphanol group was significantly decreased compared with that of the control group (risk ratio [RR]=0.17, 95% CI [0.09, 0.33], P<0.00001). Incidences of opioid-induced cough in the butorphanol group resulting in mild cough (RR=0.30, 95% CI [0.11, 0.78], P=0.01), moderate cough (RR=0.08, 95% CI [0.03, 0.22], P<0.00001), or severe cough (RR=0.08, 95% CI [0.02, 0.30], P=0.0001) were significantly lower than those of the control group. Conclusion This meta-analysis suggested that butorphanol can effectively prevent the incidence of opioid-induced cough and reduce the severity of opioid-induced cough.
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Affiliation(s)
- Jian Zhang
- Department of Anesthesiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Shuai Miao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
| | - Qing Tu
- Department of Anesthesiology, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, Hebei, China
| | - Mengzhu Shi
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
| | - Lan Zou
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
| | - Su Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
| | - Guanglei Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
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Liu MQ, Li FX, Han YK, He JY, Shi HW, Liu L, He RL. Administration of fentanyl via a slow intravenous fluid line compared with rapid bolus alleviates fentanyl-induced cough during general anesthesia induction. J Zhejiang Univ Sci B 2017; 18:955-962. [PMID: 29119733 DOI: 10.1631/jzus.b1600442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Fentanyl-induced cough (FIC) is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoperative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether administering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. METHODS A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists (ASA) grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 μg/kg via direct injection (control group) or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. RESULTS Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction (9.1%, 95% confidence interval (CI): 6.7%-11.4% vs. 55.9%, 95% CI: 51.8%-60.0%, P=0.000), as were the severity grades (P=0.000). There were no statistical differences between the two groups with regard to other adverse reactions (P>0.05). CONCLUSIONS The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.
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Affiliation(s)
- Min-Qiang Liu
- Institute of Anesthesiology, Shenzhen Third People's Hospital, Shenzhen 518112, China
| | - Feng-Xian Li
- Institute of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, China
| | - Ya-Kun Han
- Institute of Anesthesiology, Shenzhen Third People's Hospital, Shenzhen 518112, China
| | - Jun-Yong He
- Institute of Anesthesiology, Shenzhen Third People's Hospital, Shenzhen 518112, China
| | - Hao-Wen Shi
- Institute of Anesthesiology, Shenzhen Third People's Hospital, Shenzhen 518112, China
| | - Li Liu
- Institute of Anesthesiology, Shenzhen Third People's Hospital, Shenzhen 518112, China
| | - Ren-Liang He
- Institute of Anesthesiology, Shenzhen Third People's Hospital, Shenzhen 518112, China
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Goyal VK, Bhargava SK, Baj B. Effect of preoperative incentive spirometry on fentanyl-induced cough: a prospective, randomized, controlled study. Korean J Anesthesiol 2017; 70:550-554. [PMID: 29046775 PMCID: PMC5645588 DOI: 10.4097/kjae.2017.70.5.550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 11/26/2022] Open
Abstract
Background Fentanyl-induced cough (FIC) has a reported incidence of 13–65% on induction of anesthesia. Incentive spirometry (IS) creates forceful inspiration, while stretching pulmonary receptors. We postulated that spirometry just before the fentanyl (F) bolus would decrease the incidence and severity of FIC. Methods This study enrolled 200 patients aged 18–60 years and with American Society of Anesthesiologists status I or II. The patients were allocated to two groups of 100 patients each depending on whether they received preoperative incentive spirometry before fentanyl administration. Patients in the F+IS group performed incentive spirometry 10 times just before an intravenous bolus of 3 µg/kg fentanyl in the operating room. The onset time and number of coughs after fentanyl injection were recorded as primary outcomes. Any significant changes in blood pressure, heart rate, or adverse effects of the drug were recorded as secondary outcomes. Results Patients in the F+IS group had a significantly lower incidence of FIC than in the F group (6% vs. 26%) (P < 0.05). The severity of cough in the F+IS group was also significantly lower than that in group F (mild, 5 vs. 17; moderate 1 vs. 7; severe, 0 vs. 2) (P < 0.05). The median onset time was comparable in both groups (9 s [range: 6–12 s] in both groups). Conclusions Preoperative incentive spirometry significantly reduces the incidence and severity of FIC when performed just before fentanyl administration.
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Affiliation(s)
- Vipin Kumar Goyal
- Department of Anesthesiology, Mahatma Gandhi Medical College, Jaipur, India
| | | | - Birbal Baj
- Department of Anesthesiology, Mahatma Gandhi Medical College, Jaipur, India
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