fentanyl (Fentanyl Dura / fentanyl, Lavipharm / fentanyl, Recordati)

Safety and Efficacy of Remimazolam Combined with Esketamine for Anesthesia in Elderly Patients Undergoing ERCP: A Randomized Controlled Trial.

Yu Yongbo Y, Wang Jiyuan J, Zhang Qianqian Q, Xia Xiaoqiong X et al.

Older adults undergoing ERCP are particularly susceptible to sedation-related respiratory and circulatory adverse events. This trial compared the safety and efficacy of remimazolam-esketamine with propofol-fentanyl, with identical standardized nasopharyngeal airway-assisted respiratory management in both groups. This single-center, prospective, randomized, parallel-group superiority trial enrolled 160 patients aged 60-80 years with American Society of Anesthesiologists physical status I-III who were scheduled for elective ERCP. Participants were randomly assigned 1:1 to remimazolam-esketamine (RE group; n=80) or propofol-fentanyl (PF group; n=80). Both groups received identical nasopharyngeal airway placement, oxygen delivery, capnography, and rescue algorithms; the randomized intervention was the anesthetic drug regimen. The primary outcome was composite sedation-related adverse events (SRAEs), comprising prespecified hypotension, bradycardia, hypoxemia, or respiratory depression from anesthesia induction to endoscope withdrawal. Analyses followed the intention-to-treat principle. Composite SRAEs occurred in 14 of 80 patients (17.5%) in the RE group and 28 of 80 patients (35.0%) in the PF group (RR, 0.50; 95% CI, 0.29-0.88; risk difference, -17.5 percentage points; 95% CI, -30.9 to -4.1; P=0.016). The adjusted RR was 0.49 (95% CI, 0.31-0.78; P=0.003). Anesthetic regimen success was similar between groups (97.5% vs 98.8%). Induction was modestly longer with RE, whereas eye-opening and modified Aldrete recovery time were slightly shorter. In this selected population of older patients undergoing ERCP, the remimazolam-esketamine regimen was associated with fewer composite SRAEs than propofol-fentanyl while achieving a similar anesthetic regimen success rate. Induction was modestly longer. Tachycardia, hypertension, and psychotomimetic symptoms were numerically more frequent with RE, but event counts were small and estimates were imprecise. Multicenter studies are required to confirm generalizability.

Association Between Initial Injection Volume and Radiographic Catheter Alignment in Continuous Deep Serratus Anterior Plane Block for Minimally Invasive Cardiac Surgery: A Single-Center Retrospective Observational Study.

Toyama Ayano A, Iizuka Yusuke Y, Fukano Kentaro K, Saito Taishi T et al.

Background Continuous serratus anterior plane block (SAPB) is used for analgesia after thoracic and cardiac surgery. However, no standardized catheter placement method exists. This study investigated the association between initial injection volume and radiographic catheter alignment after minimally invasive cardiac surgery (MICS). Methods This retrospective cohort study included patients who underwent continuous SAPB after MICS between April 2021 and September 2024. Patients were divided into three groups based on initial bolus volume: low (≤ 30 mL), medium (40 mL), and high (≥ 50 mL). The primary outcome was radiographic catheter alignment assessed on frontal chest radiographs, categorized as favorable or unfavorable using predefined criteria. Secondary outcomes included fentanyl consumption and rescue analgesic administrations within 48 hours. Exploratory analysis evaluated associations between catheter alignment and analgesic use. Results The low-, medium-, and high-volume groups included 20, 33, and 45 patients, respectively. Favorable radiographic alignment was observed in 14 of 20 patients (70.0%) in the low-volume group, 32 of 33 patients (97.0%) in the medium-volume group, and 40 of 45 patients (88.9%) in the high-volume group (p = 0.015). Fentanyl consumption and rescue analgesic use did not differ significantly among groups. However, in an exploratory subgroup analysis, patients with favorable alignment required fewer rescue analgesic administrations than those with unfavorable alignment. Conclusion During continuous SAPB for MICS, an initial bolus volume of 40 mL or greater was associated with favorable radiographic alignment. The clinical relevance of these findings for postoperative analgesic outcomes warrants further prospective investigation.

Same name, different drugs: variability of fentanyl ('dope') products sold under the same label.

Hochstatter Karli R KR, Nadel Talia T, Gryczynski Jan J, Waninger Brent B et al.

Unregulated opioid markets are increasingly characterized by complex and variable drug compositions. In North-eastern and Mid-Atlantic US street opioid markets, fentanyl-containing powders are commonly sold in stamped glassine bags. These "stamps" function as branding and are often used by people who use drugs, harm reduction programs and public health agencies as informal indicators of product composition or risk. This study quantified the extent to which stamp identity is associated with the presence and concentration of fentanyl and co-occurring compounds. We analyzed 1153 drug samples across 475 stamps collected during 2024-2025 in Philadelphia, Pennsylvania; Delaware; and Maryland. Laboratory testing identified compound presence and quantified concentrations. Multivariable logistic regression estimated stamp-specific probabilities of compound detection, and mixed-effects models generated intraclass correlation coefficients (ICCs) to assess clustering by stamp. Fentanyl was nearly ubiquitous (95.3%) but varied widely in concentration within stamps (<1% to >20%), indicating that branding was a poor indicator of potency. Several adulterants, including medetomidine (prevalence: 64.8%) and xylazine (prevalence: 42.2%), exhibited moderate-to-high clustering by stamp (ICCs up to 0.70), but substantial within-stamp inconsistency remained. Predicted probabilities varied widely, with two-thirds of compound-stamp combinations between 20% and 80%. Concentration analyses demonstrated inconsistent dosing, particularly for fentanyl (ICC=0.15). In this region, street opioid stamp branding is an unreliable indicator of fentanyl potency and only partially informative for some adulterants. Products sold under the same stamp often differ in composition and compound concentration, suggesting that stamp-based risk assessment is insufficient and reinforcing the value of sample-level drug checking.

ERJ Podcast August 2026: Fentanyl or morphine for persistent dyspnoea in COPD.