Prophylactic fentanyl

In preparation for chest discomfort during alcohol injection, prophylactic analgesic medication (eg. fentanyl 25 mm IV) is administered. Antithrombotic prophylaxis with intravenous, weight-adjusted heparin is given to maintain an activated clotting time of 200 to 250 seconds. 

A 65-year-old man undergoing elective sternal debridement and rewiring was given a prophylactic infusion of vancomycin 1 g preoperatively. Anesthesia was induced with thiopental, suxamethonium, and fentanyl, and maintained with fentanyl, vecuronium, and isoflurane. A few minutes after wound irrigation with bacitracin (about 25U/ml), his blood pressure fell precipitously, necessitating intravenous fluids and adrenaline. His face and arms were flushed. Afterwards, he reported having had a rash several years before after the use of an over-the-counter ointment composed of polymyxin B, bacitracin, and neomycin. 

Like other opioids, fentanyl can cause pruritus. Prophylactic intravenous ondansetron 8 mg with hyperbaric bupivacaine 7-10 mg and fentanyl 25 pg significantly reduced the incidence of intrathecal fentanyl-induced pruritus in 125 patients undergoing knee arthroscopy or urological surgery in a randomized, double-blind, placebo-controlled trial (17). The incidence of pruritus was 39% with ondansetron and 68% with placebo. 

Prophylactic nalbnphine 4 mg and droperidol 0.625 mg with minidose lidocaine + fentanyl spinal anesthesia in a randomized, double-blinded, controlled stndy in 62 patients having outpatient knee arthroscopy provided significantly better analgesia and rednced nansea and pmritns than in another 62 patients who received only nalbnphine 4 mg with minidose lidocaine + fentanyl spinal anesthesia (71). 

Gurkan Y, Toker K. Prophylactic ondansetron reduces the incidence of intrathecal fentanyl-induced pruritus. Anesth Analg 2002 95(6) 1763-6. 

In a placebo-controUed study of induction of anesthesia with a combination of propofol -f fentanyl in 90 patients aged over 60 years, prophylactic intravenous ephedrine 0.1 or 0.2 mg/kg given 1 minute before induction of anesthesia significantly attenuated the fall in blood pressure and heart rate that is usually observed (14). Prophylactic use of ephedrine may be useful in preventing the occasional instances of cardiovascular collapse recorded after induction of anesthesia using these agents in elderly people. 

In preparation for chemoembolization, all patients fast overnight and are hydrated with intravenous fluids prior to the procedure. Prophylactic antibiotics, corticosteroids (Decadron), and antiemetics (Odanse-tron, Zofran, etc.) are variably given at the outset of the procedure depending on institutional protocols. At MDACC, antibiotics are not administered routinely prior to the procedure but Decadron and Zofran are given. Sedation is typically accomplished by intravenous narcotics (fentanyl and dilaudid), in addition to midazolam HCl (Versed) or other benzodiazepines. For patients with carcinoid or pancreatic neuroendocrine metastasis to the hver, 200 pg of octreotide are given just prior to the procedure and additional doses of octreotide 200 pg, are administered as needed to control the side effects of carcinoid syndrome (carcinoid crisis - hypertension, flushing, etc.). 

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