Background: Some critically ill patients require rapid sequence intubation in the emergency department, and ketamine is one sedative agent employed, due to its relative haemodynamic stability. Tachycardia and hypertension are frequent side effects, and in less stable patients, shock can be unmasked or exacerbated. The use of fentanyl as a co-induction agent may lead to a smoother haemodynamic profile post-induction, which may lead to reduced mortality in this critically ill cohort. This randomised controlled trial aims to compare the effect of administering fentanyl vs placebo in a standardised induction regimen with ketamine and rocuronium on (a) the percentage of patients in each group with a systolic blood pressure outside the range of 100-150 mm Hg within 10 minutes of induction, (b) the laryngoscopic view, and (c) 30-day mortality.
Methods/design: Three hundred patients requiring rapid sequence intubation in participating emergency departments will be randomised to receive either fentanyl or placebo (0.9% saline) in addition to ketamine and rocuronium according to a standardised, weight-based induction regimen. The primary outcome measure is the percentage of patients in each group with a systolic blood pressure outside the range of 100-150 mm Hg within 10 minutes of induction. Secondary outcome measures include the laryngoscopic view, percentage of first pass success, 30-day mortality and number of ventilator-free days at 30 days.
Discussion: The effect of adding fentanyl to an induction regimen of ketamine and rocuronium will be evaluated, both in terms of post-intubation physiology, the effect on intubating conditions, and 30-day mortality.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/aas.13309 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Transdermal Buprenorphine Patch in the Management of Postoperative Acute Pain Following Mandibular Resection and Reconstruction.
J Oral Maxillofac Surg
December 2024
Associate Professor, Department of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Background: Transdermal buprenorphine is used for the management of postoperative pain. Its effectiveness for the postoperative pain management following mandibular resection and reconstruction has yet to be evaluated.
Purpose: To evaluate the efficacy of transdermal buprenorphine patch (TBP) in managing postoperative pain after mandibular resection and reconstruction with anterior iliac crest graft.
Effect of Continuous Erector Spinae Plane Block on Postoperative Recovery in Patients Undergoing Minimally Invasive Cardiac Surgery: A Prospective, Randomized Controlled Clinical Trial.
Curr Med Sci
December 2024
Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Objective: To investigate whether continuous erector spinae plane block (ESPB) improves the quality of recovery (QoR) and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac surgery.
Methods: This was a single-center, double-blind, prospective, randomized, placebo-controlled trial. A total of 120 patients were randomized to groups at a 1:1 ratio.
Exploring Opioid Use Disorder Outcomes by Quantitative Urinalysis: Post Hoc Analysis of a Phase 3 Randomized Clinical Trial.
J Addict Med
December 2024
From Camurus AB, Lund, Sweden (SP, FT); New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY (EVN); and Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY (MRL, SLW).
Article Synopsis
- Opioid use disorder (OUD) is a pressing global issue, and while urine drug screenings help monitor treatment responses, they typically provide only yes/no results, complicating comparisons between studies due to varying analytical cutoffs.
- This study analyzed data from a 31-week trial involving 428 participants to compare the efficacy of CAM2038 (subcutaneous buprenorphine) to daily sublingual buprenorphine/naloxone, using quantitative urine drug tests to evaluate different cutoffs for opioid detection.
- Results showed that higher cutoff values led to more pronounced differences in treatment effectiveness favoring CAM2038, suggesting that quantitative urinalysis can offer
Use of dexmedetomidine during light versus deep anaesthesia on postoperative delirium among elderly patients undergoing major non-cardiac surgery: protocol for a multicentre randomised factorial trial.
BMJ Open
November 2024
Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
Introduction: Elderly patients are at a high risk of postoperative delirium (POD), leading to increased postoperative morbidity and mortality. The use of dexmedetomidine and depth of anaesthesia may influence POD. This study aims to determine the effects of dexmedetomidine infusion versus normal saline placebo during light versus deep anaesthesia on POD among elderly patients undergoing major non-cardiac surgery.
View Article and Find Full Text PDFNebulized fentanyl does not improve exercise capacity or dyspnoea in fibrosing interstitial lung disease.
Exp Physiol
January 2025
Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
Exercise intolerance and exertional dyspnoea are hallmarks of fibrosing interstitial lung disease (FILD) and are associated with worse prognosis and quality of life. Activation of pulmonary vagal afferents influences the ventilatory pattern and contributes to the sensation of dyspnoea. We tested the hypothesis that nebulized fentanyl, which might attenuate aberrant pulmonary afferent activity in FILD, reduces ventilation and dyspnoea while extending exercise endurance time (EET).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!