No description available.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / The use and abuse of fentanyl has risen drastically over the last several decades. The abuse of this substance has created a hazardous situation for law enforcement and first responders because they could arrive at locations and not necessarily know that they will encounter fentanyl or a fentanyl analog. Fentanyl analogs are substances that have a similar structure to fentanyl, and while the analogs may have additional or altered groups on the molecule, the backbone structure remains similar. This work focus on the electrochemical characterization of fentanyl as a stepping stone for the detection of both fentanyl and later fentanyl analogs by electrochemistry. The metabolic reaction of fentanyl is an N-dealkylation to norfentanyl, occurring in the liver, and can be mimicked by electrochemistry through the irreversible oxidation of fentanyl. This electrochemical reaction is hypothesized to generate electroactive metabolites in solution. The combination of the visualization of both the irreversible oxidation with the development of the additional metabolic electrochemical peaks would constitute a unique electrochemical signature for fentanyl and fentanyl analogs towards a universal rapid screening assay. The electrochemical behavior of fentanyl was characterized in depth using multiple electrochemical techniques such as cyclic voltammetry (CV), square wave voltammetry (SWV) and differential pulse voltammetry (DPV). The optimization of the supporting electrolyte, the potential range, and methods to decrease the background current were explored with CV. To work towards a more portable system, screen printed electrodes were used. The observation of the metabolic peaks remained challenging, and different methods were attempted to achieve it. The quantification of fentanyl was successfully demonstrated using the different electrochemical systems proposed in this work. The electrochemical characterization of fentanyl and the optimization of multiple experimental parameters were the first step in developing a universal, rapid, electrochemical sensing method for the detection of fentanyl and fentanyl analogs. / 2023-02-28

Aim: To investigate the relationship between effective fentanyl sublingual spray (FSS) doses for breakthrough cancer pain (BTCP) and around-the-clock (ATC) transdermal fentanyl patch (TFP). Methods: Adults tolerating ATC opioids received open-label FSS for 26 days, followed by a 26-day double-blind phase for patients achieving an effective dose (100-1600 mu g). Results: Out of 50 patients on ATC TFP at baseline, 32 (64%) achieved an effective dose. FSS effective dose moderately correlated with mean TFP dose (r = 0.4; p = 0.03). Patient satisfaction increased during the study. Common adverse events included nausea (9%) and peripheral edema (9%). Conclusion: FSS can be safely titrated to an effective dose for BTCP in patients receiving ATC TFP as chronic cancer pain medication. ClinicalTrials.gov identifier: NCT00538850

No description available.

No description available.

Abstract not available

Background: One population prone to aspiration pneumonia and impaired cough is the postoperative patient. Postoperative pneumonia is the third most common complication among surgical patients after urinary tract and wound infections (Wren, Martin, Yoon, & Bech, 2010). A patient who has their surgical course complicated by aspiration pneumonia has increased morbidity, increased length of hospital stay and places greater demands on the health system. Mortality rates are cited as high as 70% (Wren, et al., 2010). Despite the prevalence of postoperative pneumonia and the high morbidity and mortality rates, little is known about the effect of anaesthesia on swallowing and airway protection. This study investigated the effect of clinical doses of fentanyl on suppressed cough reflex in healthy participants. Materials and Methods: After receiving ethical approval, 14 young, healthy participants gave informed written consent and completed the study protocol. Each participant received a total of 2 mcg/kg of fentanyl in four doses administered at five-minute intervals. Fentanyl effect site concentrations (ESC) were estimated using a standard pharmacokinetic model. During the administration period, suppressed cough response testing (SCR) with nebulised citric acid was performed after each fentanyl dose. Citric acid was presented in increments of 0.2M from each participant’s baseline cough response until a present-strong response was achieved. During the post-administration period, SCR was compared with reducing effect site concentrations to determine the time course for resolution of cough suppression. Results: Suppressed cough threshold increased and decreased in parallel with modeled fentanyl effect site concentrations. Mean citric acid concentration increased from 0.5M at baseline to 0.6M after 0.5 mcg/kg of fentanyl, 0.7 M after 1 mcg/kg of fentanyl, 0.9M after 1.5 mcg/kg of fentanyl and 1.2M after 2 mcg/kg of fentanyl. Predicted effect site concentrations after final doses of fentanyl (2 mcg/kg) were 1.89 ng/mL (1.81-1.96), well within the range seen clinically in the postoperative period. After the final dose of fentanyl, participants had on average 3.4 increments of change in their cough response (at increments of 0.2M). Conclusion: SCR testing with citric acid is sensitive enough to mirror changes in fentanyl ESC in healthy, young participants. The degree of reflex suppression seen has been associated with an 8-fold increase in aspiration risk in the general medical patient with dysphagia (Miles, Moore, McFarlane, Lee, Allen, Huckabee, 2013). Further research into the application of SCR in the postoperative period may help clinical decisions regarding safety to commence oral intake.

Inom ambulanssjukvård är en av ambulanssjuksköterskans uppgifter att kunna ge patienten adekvat smärtlindring. Tidigare har det krävts en intravenös infart för detta, men sedan några år finns möjligheten att kunna ge smärtlindring intranasalt. Syftet med studien är att undersöka sjuksköterskors erfarenhet av att administrera intranasal smärtlindring i den prehospitala vårdmiljön. Studien är kvalitativ och baseras på åtta intervjuer med sjuksköterskor, vilka har erfarenhet av att ge smärtlindring intranasalt. Intervjuerna analyserades därefter enligt Lundman och Hällgren Graneheim (2012) för att kunna beskriva informanternas levda erfarenhet. Följande fem kategorier utkristalliserade sig: Förebyggande, Smidighet, Osäkerhet, Oerfarenhet och Biverkningar. Varje kategori hade även två till tre underkategorier. Resultatet belyser intranasal smärtlindring som ett bra alternativ till intravenös smärtlindring inom ambulanssjukvård. Det lyfts också fram att det känns skönt att kunna erbjuda smärtlindring utan att orsaka patienten mer smärta genom att behöva etablera en intravenös infart. Det framkommer även att den intranasala smärtlindringen hellre används på barn än på vuxna. Vid vård av vuxna patienter är tryggheten störst med intravenös smärtlindring. Det förefaller som att barn helst inte ska utsättas för nålstick. Det framkommer också att intranasal smärtlindring fungerar bättre på barn än på vuxna inom ambulanssjukvård.

Class of 2011 Abstract / OBJECTIVES: To compare fixed equianalgesic doses of morphine and fentanyl with regard to analgesic response for patients who presented to the ED with moderate to severe pain. METHODS: A retrospective cohort study of clinical data obtained through patient medical record review. Median pain reduction on the numeric pain scale was compared between the morphine and fentanyl groups. Independent variables of interest included: Age, sex, weight, initial pain score, injury severity, triage severity and injury type. RESULTS: : Pain scores were reported to be worse in the fentanyl group, p= 0.0002. However pain reduction was similar between the groups; median (IQR) of 2 (1-3) and 2 (1-4) in the morphine and fentanyl groups respectively, p= 0.6707. Injuries were more severe in the fentanyl group; injury severity score (ISS) median (IQR) of 5 (1-9) and 9 (3-12), p=0.0312 and more patients in the fentanyl group required additional opioids within 30 min of their first ED opioid dose, 15 (18%) and 31 (37%), p=0.006. CONCLUSION: Patients in both the morphine and fentanyl groups received similar analgesic response. Patients in the fentanyl group had a higher severity of injury, received higher doses of opioids from the EMS, and required the second dose of opioid sooner than patients in the morphine group.