Inhaled fentanyl as a method of analgesia

A study was undertaken to investigate the use of fentanyl by aerosol for postoperative analgesia. Seven patients had placebo, six received fentanyl 100 micrograms and seven were given fentanyl 300 micrograms. A significant improvement in postoperative pain, as assessed by linear visual analogue scale, was achieved in the higher dose group, and in both fentanyl groups the time to alternative analgesia was significantly longer than in the control group. Serum fentanyl levels after inhalation of 100 micrograms reached a plateau around 0.04 ng/ml and after 300 micrograms at around 0.1 ng/ml after 15 minutes. Inhaled fentanyl may have a useful analgesic effect despite these low serum levels; this supports the hypothesis that the mode of analgesia from inhaled opioids may be different from that after other routes of administration. There were no adverse effects such as respiratory depression, bronchospasm, nausea or drowsiness.     

Chronic renal failure: factors influencing nephrology referral

Factors influencing referral of all 304 patients who developedpersistent renal failure during one year were studied in thestable Grampian population. The annual incidence of chronicrenal failure (CRF) (creatinine     

Short-Ti inversion-recovery pulse sequence: analysis and initial experience in cancer imaging

Inversion recovery (IR), commonly considered a pulse sequence capable of producing T1-weighted images with excellent display of normal anatomy, is versatile: The null point and peak time provide a useful, succinct summary of the properties of IR and its capacity for producing both T1- and T2-weighted images. Shortening of the inversion time (TI) and creation of a short-TI inversion-recovery (STIR) pulse sequence increases sensitivity to malignancy and other abnormalities by making the effects of prolonged T1 and T2 on signal intensity additive and by nulling the signal from fat. The authors examined over 300 patients with various malignancies and compared STIR images with T1- and T2-weighted images obtained at 0.5 T. In 43 cases, signal-difference-to-noise ratios (SD/Ns) were calculated between tumor, fat, and muscle. In general, STIR images demonstrated tumor as a conspicuously high-intensity area in a background of muted, discernible anatomic detail. The good contrast achieved with STIR sequences between tumor and fat (SD/N = 18.1) and tumor and muscle (SD/N = 12.9) consolidated into a single image the information contained separately on T1- and T2-weighted images, which facilitates efficient detection and localization of malignancy.     

Solitary rectal ulcer syndrome: findings at barium enema study and defecography

Sixteen cases of histopathologically proved solitary rectal ulcer syndrome were encountered. Fifteen patients underwent barium enema study; in nine cases the findings--including rectal stricture, granularity of the mucosa, and thickened rectal folds-were nonspecific. In six cases the study was normal. All patients had a long history of defecation disorders, and defecography was performed in all. In seven cases, intussusception of the rectal wall was seen; in another case the intussusception was accompanied by a rectocele. One case showed rectal prolapse. In four cases, failed relaxation of the puborectalis occurred and prevented the passage of the bolus; in another case there was abnormal perineal descent. In two patients studies were normal. In patients with defecation disorders, the possibility of this syndrome should be considered. Defecography is the method of choice for establishing the diagnosis.     

Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery

We have compared, in 51 ASA II and III patients undergoing coronaryartery bypass surgery, an inhaled anaesthetic technique basedon desflurane, supplemented with low-dose (10 µg kg^–1)fentanyl, with an i.v. technique using high-dose (50 µgkg^–1) fentanyl with midazolam for induction. Satisfactoryrecords were available for analysis in 50 patients. There wereno differences between groups in operating time, cardiopulmonarybypass time, aortic cross-clamp time or duration of stay inthe intensive care unit after surgery. Desflurane maintainedmean systemic arterial pressure at the awake level during incisionand sternotomy (end-tidal concentrations 3.7% and 4.6%, respectively)but decreased it significantly at all other times. With fentanyl,mean systemic arterial pressure was unchanged from a wake valuesduring induction and laryngoscopy but increased significantlyat incision and sternotomy by 8% and 12.8%, respectively, toexceed the desflurane group at sternotomy by 20 mm Hg (P <0.001). With desflurane, heart rate remained at 60–67beat min^–1 at all times before cardiopulmonary bypass.This was always lower than the fentanyl group by 5–15beat min^–1 and the difference was significant at induction,during skin preparation and before aortic cannulation. In comparisonwith the desflurane group, cardiac index was significantly greaterin the fentanyl group at induction, laryngoscopy and duringskin preparation, but was significantly less before aortic cannulation.The need for vasodilator intervention was significantly morecommon in the fentanyl group before, during and after cardiopulmonarybypass and for ß adrenoceptor block before cardiopulmonarybypass. At the time of sternotomy, 10 patients in the fentanylgroup were receiving glyceryl trinitrate compared with one inthe desflurane group. There were no deaths during the periodin hospital or any cases of awareness under anaesthesia. Desfluranesupplemented with lowdose fentanyl produced a controlled haemodynamicstate suitable for patients at risk of myocardial ischaemiawithout recourse to large end-tidal concentrations. (Br. J.Anaesth. 1994; 72: 430–438)