Background: The combination of propofol fentanyl for sedation during colonoscopy is characterized by high prevalence of side effects. Etomidate fentanyl provides fewer hemodynamic and respiratory complications. The aim of our study was to compare the safety and efficacy of propofol fentanyl and etomidate fentanyl for conscious sedation in elective colonoscopy.Methods: This double blind clinical trial was conducted on 90 patients aged between 18- 55 years old who were candidates for elective colonoscopy. Patients were randomized to receive sedation with fentanyl plus propofol or etomidate. Two minutes after injecting 1 micro/kg of fentanyl, the patients received 0.5mg/kg propofol by infusion (25 m/kg/min) or 0.1 mg/kg etmoidate (15 m/kg/min). Pulse rate, mean arterial blood pressure, respiratory rate, and saturation of peripheral oxygen (SPO2) were monitored. In addition, the patient and colonoscopist satisfaction, the recovery time, sedation and pain score in both groups were assessed.Results: Sedation score in propofol group was higher. Pain score as well as the physician and patient satisfaction showed no significant difference between the two study groups. Hemodynamic changes and arterial saturation were the same in both groups. The duration of recovery was 1.27±0.82 minutes in the etomidate group; versus 2.57±2.46 minutes in the propofol group (P=0.001). Recovery time in the etmoid group was 2.68±3.14 minutes and in the propofol group was 5.53±4.67 minutes (p=0.001).Conclusion: The combination of fentanyl and etomidate provides an acceptable alternative to sedation with fentanyl and propofol with the advantage of significantly faster recovery time, in the outpatient setting.

Cataract surgery is the most common procedures in geriatrics. There has been a significant shift toward the use of topical anesthesia with light sedation for routine cataract surgery. This study evaluated the sedation, cooperation and pain score, patient and surgeon satisfaction, PONV and delirium following use of three intravenous sedation techniques in phacoemulsification under topical anesthesia for cataract surgery.In this controlled clinical trial study, 150 patients who were candidate for phacoemulsification surgery were randomly divided in three groups. After oral explanation and topical anesthesia with tetracaine 0.5%, first group received fentanyl 1-1.5, µg/kg and ketamine 0.2mg/kg intravenously. Then propofol 10-20, µg/kg/min for second group and lidocaine 0.7mglkg for third group were Administered in addition to drugs of first group. Data were collected analyzed.There were no differences in the demographics data, preoperative BP and HR between the 3 groups. The mean pain score in 3 groups were 1.20±2.14, 1.78±2.68, and 2.18±3.05 respectively. Frequency of appropriate sedation in 3 groups was 80%, 86% and 78% respectively. Frequency of appropriate cooperation in 3 groups was 70%, 76% and 76% respectively. No significant differences in other parameters were observed in 3 groups.In previous studies, the preference of some sedation methods to other protocols was proved but in present study this issue was not significant. This may be due to patient selection, preoperative psychological preparation; optimum drugs dose selection, administration quality, compatible drugs combination and surgeon skill. There is necessary to more studies for detection of these effects on sedation quality.

Introduction: Intravenous (IV) administration of fentanyl bolus elicits cough in more than one-third of the patients. Coughs may sometimes be explosive leading to hypoxia, vomiting, with increases in intracranial, intraocular and intraabdominal pressures.Materials & Methods: This double blind clinical trial included 360 patients below 60 years with ASA status I & II, who were scheduled for elective surgeries. They were randomized into 3 groups of 120. Group I received Normal Saline as placebo, 60 secounds late fentanyl was administred slowly over a period of 30 secounds. Group II was given fentanyl over 5 secounds, 1 minute after Lidocaine, (1.5 mg/kg IV). Group III also received Normal Salin, 60 secounds before the fentanyl was given in 5 secounds. fentanyl dose was 2 mg/kg. Then, incidence and severity of cough was recorded, and the results were 0.05 was considered significant. £ analyzed using Chi square test. P.value ofResults: The incidence of cough was 2.5% in group I, 9.2% and 22.5% in groups II & III respectively. The finds showed that the incidence of cough was significantly higher in group III (P<0.001). Occurrence of cough in patients under 18 was more than those above 18 years of age in all the three groups (P=0.001).Conclusion: IV Lidocaine and, in particular, slow rate of fentanyl administration, significantly minimize fentanyl-Induced coughing. Also the incidence of evoked cough is much higher in young patients.

Introduction: Currently, using various combinations of sedative and analgesic agents has received attention for induction of sedation and analgesia due to their synergy in controlling pain and anxiety. The present study was designed with the aim of comparing dexmedetomidine-fentanyl combination with midazolam-fentanyl in this regard.Methods: In this randomized clinical trial, patients diagnosed with distal radius fracture who had visited the emergency department (ED) were allocated to either the group receiving the combination of fentanyl-midazolam or the one receiving dexmedetomidine-fentanyl for procedural sedation and analgesia (PSA) and were compared regarding analgesic characteristics, time to recovery and side effects.Results: 80 patients with the mean age of 42.08± 12.17 (18 - 60) years were randomly allocated to 2 groups of 40 (83.80% male). The 2 groups did not have a significant difference regarding baseline characteristics as well as pain severity. Mean pain score at the time of procedure was 3.47± 1.37 in dexmedetomidine and 2.85 ± 1.05 in midazolam group (p=0.025). In addition, time to recovery in dexmedetomidine and midazolam groups was 6.60± 1.86 minutes and 12.70± 1.70 minutes, respectively (p<0.001). Out of the 9 patients who experienced treatment failure, 8 (88.90%) patients were in dexmedetomidine group and 1 (11.10%) was in midazolam group (p=0.029). Absolute risk increase rate of treatment failure in case of using dexmedetomidine instead of midazolam was 17.50% (95%CI: 4.19 – 30.81) and number needed to harm was 6.00 (95% CI: 3.20 – 23.80).Conclusion: Although the combination of dexmedetomidine-fentanyl had a shorter time to recovery compared to midazolam-fentanyl for induction of sedation and analgesia, the treatment failure rate in case of using dexmedetomidine with 1 mg/kg increased 17.5% and about 1 out of each 6 patients needed a rescue dose.

Intraoperative anaphylaxis can lead to significant morbidity and mortality but rarely occurs. Vascular collapse and bronchospasm are the hallmarks of this condition. numerous agents have been identified as triggers of intraoperative anaphylaxis, the most common being neuromuscular blocking drugs and latex. But opioids rarely cause anaphylaxis. We report an unusual case of intraoperative anaphylaxis with pulmonary edema during a routine plastic surgery procedure was due to iv fentanyl.

Introduction: Labor pain is the main reason preventing pregnant women from having natural vaginal delivery (NVD).In order to reduce the labor pain, several ways have been introduced, among which spinal analgesia with fentanyl is considered the most effective.fentanyl is a lipophilic opioid with the degree of 75-125 times more potent than morphine.This study aims at evaluating the analgesic effects of fentanyl on the process of NVD as well as the possible risks involved for the neonate after spinal injection in pregnant women.Materials and Methods: This is a single blinded clinical trial on 100 pregnant women having their first or second pregnancy who referred to Mashhad Islamic Azad University hospitals for NVD in 1389 HS. This study benefited from using the accessible method of sampling and considering he ethical issues as well applying the inclusion / exclusion criteria. Having informed the patients and their spouses about the analgesic methods, the researchers received the patients’ consent and divided them into two groups of “case” and “control” with 50 patients, each. The case group received 75 µg of fentanyl with the concentration of 0.05 mg/ml added  to sodium chloride and distilled water. These patients used the drug after getting into the cervical dilatation of 5 or 6 centimeters . The control group received no analgesic drug and experienced the natural process of labor and delivery. Systolic & Diastolic blood pressures, heart rate, SP02, the degree of cervical dilatation and effacement, fetal heart rate (FHR) and Apgar rate were evaluated during the intervals of 1 and 5 minutes after birth. Finally, these data were compared and analyzed with the statistical methods of T-test, Chi-square, Fisher and Man-Whitney, using SPSS.Results: There was no significant difference between the two study groups in terms of maternal systolic & diastolic blood pressure, SP02 and FHR. Shortly after the injection of fentanyl, the patients in the case group started complaining about itching in the upper part of their abdomen and chest that automatically subsided after about 20-30 minutes. There was a statistically significant difference of the pain rate between the two groups (Pearson Chi-square=62.95, df=2, p=0.0001). Mild pain was seen in 82%, moderate pain in 16% and sever pain in 2% of the patients in the case group. On the other hand, only 4% of the patients in the control group were reported to have mild pain, 22% had moderate pain and the other 74% suffered from severe pain. Duration of labor was longer for the case group and the number of cases resulting in cesarean section was not statistically different between the two groups.Conclusion: Spinal injection of 75µg fentanyl provides appropriate analgesia without any considerable side effects for the pregnant women who apply for NVD.

Background: The risk of anesthesia increases with age, so it is necessary to choose a safe and effective method. In this study, we compared the effectiveness of intranasal fentanyl with intravenous fentanyl in patients undergoing cataract surgery. Methods: This study was a triple-blind prospective randomized clinical trial (The patient, physician, and data analyzer were unaware of the patient grouping). The study was performed from April 2017 to March 2019 in Feyz Hospital, Isfahan, Iran. 90 patients over 18 years of age who were candidates for cataract surgery were included in the study and were divided in two groups receiving intravenous fentanyl (IVF) or intranasal fentanyl (INF). The dose of fentanyl in both groups was 1. 5 μ g/kg with a maximum of 100 μ g. In the IVF group, 1 ml of normal saline was dripped into each nasal passage 10 minutes before surgery and intravenously fentanyl was injected 2 minutes before surgery. In the INF group, 1 ml of fentanyl was administered into each nostril 10 minutes before surgery and 2 ml of saline was administered intravenously two minutes before surgery. Results: In this study, there was no significant difference between the two groups in terms of mean heart rate (P=0. 762), mean arterial blood oxygen saturation (P=0. 262), mean systolic blood pressure (P=0. 264), mean arterial blood pressure (0. 462), satisfaction rate Patient (P=0. 231), duration of surgery (P=0. 612) and pain intensity (P=0. 87). But in the intravenous fentanyl group (IVF), the level of sedation (P=0. 002) and the level of surgeon satisfaction (P<0. 001) were higher than intranasal fentanyl group (INF). There was no significant difference between the two groups in terms of side effects (P=0. 171) and surgery time (P=0. 612). The mean VAS was not significantly different between the two groups. Conclusion: The study showed that intranasal administration of fentanyl compared with intravenous administration of fentanyl provided similar sedation and cardiovascular response. Intranasal administration of fentanyl is a non-invasive, safe and effective method, that is easy to use and can be a viable alternative to intravenous administration.