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Huang M, Watso JC, Belval L, et al. Low-Dose Fentanyl Does Not Alter Muscle Sympathetic Nerve Activity, Blood Pressure, or Tolerance During Progressive Central Hypovolemia. Am J Physiol Regul Integr Comp Physiol. 2021;doi: 10.1152/ajpregu.00217.2021.
Huang, M., Watso, J. C., Belval, L., Cimino Iii, F. A., Fischer, M., Jarrard, C. P., Hendrix, J. M., Hinojosa-Laborde, C., & Crandall, C. G. (2021). Low-Dose Fentanyl Does Not Alter Muscle Sympathetic Nerve Activity, Blood Pressure, or Tolerance During Progressive Central Hypovolemia. American journal of physiology. Regulatory, integrative and comparative physiology, . https://doi.org/10.1152/ajpregu.00217.2021
Huang, Mu, et al. "Low-Dose Fentanyl Does Not Alter Muscle Sympathetic Nerve Activity, Blood Pressure, or Tolerance During Progressive Central Hypovolemia." American journal of physiology. Regulatory, integrative and comparative physiology vol. (2021). doi: https://doi.org/10.1152/ajpregu.00217.2021
Huang M, Watso JC, Belval L, Cimino Iii FA, Fischer M, Jarrard CP, Hendrix JM, Hinojosa-Laborde C, Crandall CG. Low-Dose Fentanyl Does Not Alter Muscle Sympathetic Nerve Activity, Blood Pressure, or Tolerance During Progressive Central Hypovolemia. Am J Physiol Regul Integr Comp Physiol. 2021 Dec 01; doi: 10.1152/ajpregu.00217.2021. Epub 2021 Dec 01. PMID: 34851734.
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Am J Physiol Regul Integr Comp Physiol. 2021 Dec 01; doi: 10.1152/ajpregu.00217.2021. Epub 2021 Dec 01.

Low-Dose Fentanyl Does Not Alter Muscle Sympathetic Nerve Activity, Blood Pressure, or Tolerance During Progressive Central Hypovolemia.

American journal of physiology. Regulatory, integrative and comparative physiology

Mu Huang, Joseph C Watso, Luke Belval, Frank A Cimino Iii, Mads Fischer, Caitlin P Jarrard, Joseph M Hendrix, Carmen Hinojosa-Laborde, Craig G Crandall

Affiliations

  1. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, United States.
  2. Department of Applied Clinical Research, University of Texas Southwestern Medical Medical Center, Dallas, TX, United States.
  3. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.
  4. Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
  5. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, United States.
  6. US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States.

PMID: 34851734 DOI: 10.1152/ajpregu.00217.2021

Abstract

Hemorrhage is a leading cause of battlefield and civilian trauma deaths. Several pain medications, including fentanyl, are recommended for use in the prehospital (i.e., field setting) for a hemorrhaging solider. However, it is unknown whether fentanyl impairs arterial blood pressure (BP) regulation, which would compromise hemorrhagic tolerance. Thus, the purpose of this study was to test the hypothesis that an analgesic dose of fentanyl impairs hemorrhagic tolerance in conscious humans. Twenty-eight volunteers (13 females) participated in this double-blinded, randomized, placebo-controlled trial. We conducted a pre-syncopal limited progressive lower-body negative pressure test (LBNP; a validated model to simulate hemorrhage) following intravenous administration of fentanyl (75 µg) or placebo (saline). We quantified tolerance as a cumulative stress index (mmHg•min), which was compared between trials using a paired, two-tailed t-test. We also compared muscle sympathetic nerve activity (MSNA; microneurography) and beat-to-beat BP (photoplethysmography) during the LBNP test using a mixed effects model (time [LBNP stage] x trial). LBNP tolerance was not different between trials (Fentanyl: 647 ± 386 vs. Placebo: 676 ± 295 mmHg•min, P=0.61, Cohen's d = 0.08). Increases in MSNA burst frequency (time: p<0.01, trial: p=0.29, interaction: p=0.94) and reductions in mean BP (time: p<0.01, trial: p=0.50, interaction: p=0.16) during LBNP were not different between trials. These data, the first to be obtained in conscious humans, demonstrate that administration of an analgesic dose of fentanyl does not alter MSNA or BP during profound central hypovolemia, nor does it impair tolerance to this simulated hemorrhagic insult.

Keywords: Cerebral Tissue Oxygenation; Opioids; Respiration; Sympathoexcitatory

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