|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 4 | Page : 208-209
Oxycodone as a replacement to opioid to facilitate tracheal intubation
Aninda Tanggono, Cynthia Dewi Sinardja, I Putu Pramana Suarjaya
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Indonesia
|Date of Submission||22-Jun-2020|
|Date of Decision||17-Jul-2020|
|Date of Acceptance||21-Jul-2020|
|Date of Web Publication||27-Aug-2020|
Dr. Aninda Tanggono
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Jl. Pb Sudirman, Denpasar 80232, Bali
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tanggono A, Sinardja CD, Pramana Suarjaya I P. Oxycodone as a replacement to opioid to facilitate tracheal intubation. Bali J Anaesthesiol 2020;4:208-9
|How to cite this URL:|
Tanggono A, Sinardja CD, Pramana Suarjaya I P. Oxycodone as a replacement to opioid to facilitate tracheal intubation. Bali J Anaesthesiol [serial online] 2020 [cited 2020 Nov 30];4:208-9. Available from: https://www.bjoaonline.com/text.asp?2020/4/4/208/299870
Conox's qCON algorithm (Quantium Medical, Spain) was recently available in our hospital. It assesses the level of hypnosis during sedation–analgesia. The analgesic potency between oxycodone and fentanyl showed a more extended duration of action and a better analgesic effect than fentanyl and morphine. The analgesic potency of oxycodone is about 30% greater than that of morphine and slightly longer acting than morphine. Oxycodone could minimize patient hemodynamic responses to sudden stimuli such as endotracheal intubation similar to fentanyl.
The qCON monitor processes and analyzes the electroencephalogram (EEG) changes in brain electrical activity recorded by electrodes, which is placed on the patient's forehead. They calculate a dimensionless index that reflects the hypnotic component of anesthesia by evaluating changes in the recorded EEG frequency spectrum and exploit the observation that EEG oscillations change with increasing levels of sedation. Even though a direct correlation between activation and nociceptors and the sensory experience of pain is not always apparent, emotional state, degree of anxiety, attention and distraction, past experiences, memories, and other factors can either enhance or diminish the pain experience.
Awareness during anesthesia is a rare event. The Conox's qCON index is modern digital technology that facilitated the application of advanced mathematics in the diagnostics and analysis equipment. The efficacy of oxycodone and morphine may play an essential role in the analgesic efficacy and may be enhanced in long-term therapy. Oxycodone acts on the central nervous system via the μ-receptor and the κ-2b receptor. The plasma levels of oxycodone are approximately more active than morphine. The analgesic potency of oxycodone is about 30% greater than morphine. Furthermore, it is slightly acting longer than morphine, and it does not cause histamine release.
Oxycodone minimizes hemodynamic responses to sudden stimuli such as endotracheal intubation similar to fentanyl. Fentanyl, commonly administered before intubation, is a short-acting opioid, while oxycodone is a robust μ-opioid receptor agonist, and its potency is similar to morphine. The onset time of oxycodone is rapid onset time about 5–8 min.
Laryngoscopy and tracheal intubation often cause tachycardia, increased blood pressure, and arrhythmias. These hemodynamic responses to tracheal intubation are associated with an increase in plasma catecholamine concentrations and are contributed by the β-adrenergic blockade. In our experience, oxycodone routinely attenuates the sympathetic response during endotracheal intubation as well as provides stable blood pressure during intubation and better depth of anesthesia.
Oxycodone would be beneficial in daily anesthesia practice. Further studies evaluating the depth of anesthesia quantitatively, such as using Conox'x qCON, will be required to deepen our understanding regarding this matter.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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