Medicinal, Psychological, and Health Research Journal (MPHRJ)

Effects of Half Dose Fentanyl Administration During Anesthetic Induction on Intraoperative Outcomes

Document Type : Original Article

Authors

Naghi Abedini 1
Yashar Eslampoor 2

1 Associate Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Assistant Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

https://doi.org/10.22034/mphrj.2026.586272.1097
Abstract
Introduction: Given the ongoing interest in opioid sparing anesthesia and the importance of maintaining hemodynamic stability during surgery, investigation of reduced fentanyl dosing during anesthetic induction is clinically justified. Understanding the intraoperative consequences of administering half the conventional fentanyl dose may help clarify whether lower opioid exposure can effectively balance sympathetic suppression, cardiovascular stability, anesthetic adequacy, and postoperative recovery.

Material and methods: This prospective observational study was conducted at Shohada Hospital in 2025 on 50 patients undergoing surgery under general anesthesia to evaluate postoperative serum creatinine changes following intraoperative furosemide administration. Serum creatinine levels were measured every 6 hours during the first 48 postoperative hours using standardized laboratory methods.

Results: Heart rate and blood pressure parameters demonstrated significant temporal fluctuations during the first hour after anesthetic induction, with all hemodynamic changes reaching statistical significance (P<0.001). Heart rate showed an early transient increase followed by stabilization, while systolic and diastolic blood pressures initially decreased and gradually recovered over time. In addition, supplemental opioid requirement increased progressively during the first 6 intraoperative hours, with a significant overall variation in analgesic demand (P=0.032), indicating dynamic perioperative nociceptive responses.

Conclusion: Anesthetic induction was associated with transient but clinically controlled hemodynamic alterations during the early intraoperative period. Despite significant fluctuations in heart rate and blood pressure, overall cardiovascular stability was maintained throughout monitoring. Furthermore, the progressive increase in opioid requirement highlights the evolving nature of intraoperative nociceptive stimulation and emphasizes the importance of continuous analgesic titration during surgical procedures.

Graphical Abstract

Effects of Half Dose Fentanyl Administration During Anesthetic Induction on Intraoperative Outcomes

Keywords

Anesthetic induction
Hemodynamic changes
Heart rate
Blood pressure
Opioid requirement
Subjects
[1]    Bansal, V. K., Misra, M. C., & Babu, D. (2013). A prospective, randomized comparison of long-term outcomes: Chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surgical Endoscopy, *27*(7), 2373–2382.
[2]    Beyhan Sagmen, S., & Kıral, N. (2020). Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in asthma control. Revue Française d'Allergologie, *60*(1), 20–23.
[3]    Dale, O., Somogyi, A. A., Li, Y., Sullivan, T., & Shavit, Y. (2012). Does intraoperative ketamine attenuate postoperative inflammatory reactivity? A systematic review and meta-analysis. Anesthesia & Analgesia, *115*(4), 934–943.
[4]    De Kock, M., Loix, S., & Lavand'homme, P. (2013). Ketamine and peripheral inflammation. CNS Neuroscience & Therapeutics, *19*(6), 403–410.
[5]    Domagalska, M., Ciftsi, B., & Janusz, P. (2023). Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) following erector spinae plane block (ESPB) in posterior lumbar decompression: A randomized, controlled trial. European Spine Journal, *32*(12), 4192–4199.
[6]    Gorlin, A. W., Rosenfeld, D. M., & Ramakrishna, H. (2016). Intravenous sub-anesthetic ketamine for perioperative analgesia. Journal of Anaesthesiology Clinical Pharmacology, *32*(2), 160–167.
[7]    Gumus, F., Solak, I., & Eryilmaz, M. A. (2018). The effects of smoking on neutrophil/lymphocyte, platelet/lymphocyte ratios. Bratislavske Lekarske Listy, *119*(2), 116–119.
[8]    Ishizuka, M., Shimizu, T., & Kubota, K. (2013). Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. International Surgery, *97*(4), 299–304.
[9]    Kaur, S., Saroa, R., & Aggarwal, S. (2015). Effect of intraoperative low-dose ketamine on management of postoperative analgesia. Journal of Natural Science, Biology and Medicine, *6*(2), 378–382.
[10] Mohammadi, K . (2026). CHA₂DS₂ VASc, anticoagulation, echocardiographic, thrombosis. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(1), 17-25.
[11] Kissin, I. (2000). Preemptive analgesia. Anesthesiology, *93*(4), 1138–1143.
[12] Köksal, H., Ateş, D., Nazik, E. E., Küçükosmanoğlu, İ., Doğan, S. M., & Doğru, O. (2018). Predictive value of preoperative neutrophil-to-lymphocyte ratio for detecting bowel resection in hernia with intestinal incarceration. Turkish Journal of Trauma & Emergency Surgery, *24*(3), 207–210.
[13] Kwok, R. F. K., Lim, J., Chan, M. T. V., Gin, T., & Chiu, W. K. Y. (2004). Preoperative ketamine administration improves postoperative analgesia after gynecologic laparoscopic surgery. Anesthesia & Analgesia, *98*(4), 1044–1049.
[14] Lee, J. S., Kim, N. Y., Na, S. H., Youn, Y. H., & Shin, C. S. (2018). Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (Baltimore), *97*(26), e11138.
[15] McNicol, E. D., Schumann, R., & Haroutounian, S. (2014). A systematic review and meta-analysis of ketamine for the prevention of persistent post-surgical pain. Acta Anaesthesiologica Scandinavica, *58*(10), 1199–1213.
[16] Mertoglu, C., & Gunay, M. (2017). Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, *11*(Suppl. 1), S127–S131.
[17] Reinpold, W. (2017). Risk factors for chronic pain after inguinal hernia repair: A systematic review. Innovative Surgical Sciences, *2*(2), 61–68.
[18] Milanifard, M and Hashemloo, A. (2025). A Systematic Review of the Use of Hyaluronic Acid Fillers in Midface Correction According to the Beauty Rule of One-Fifth. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(1), 10-16.
[19] Serban, D., Stoica, P. L., & Dascalu, A. M. (2023). Significance of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) in predicting severity and adverse outcomes in acute calculous cholecystitis. Journal of Clinical Medicine, *12*(21), 6946.
[20] Silva, M. D., Cleghorn, M. C., Elnahas, A., Jackson, T. D., Okrainec, A., & Qureshi, F. A. (2016). Postoperative day 1 neutrophil-to-lymphocyte ratio as a predictor of 30-day outcomes among bariatric surgery patients. Surgical Endoscopy, *31*(6), 2645–2650.
[21] Singh, H., Kundra, S., Singh, R. M., Grewal, A., Kaul, T. K., & Sood, D. (2013). Preemptive analgesia with ketamine for laparoscopic cholecystectomy. Journal of Anaesthesiology Clinical Pharmacology, *29*(4), 478–484.
[22] Surhonne, N., Hebri, C., Kannan, S., Duggappa, D. R., Rs, R. R., & Mapari, C. G. (2019). Effect of anesthetic techniques on the neutrophil-to-lymphocyte ratio in patients undergoing infraumbilical surgeries. Korean Journal of Anesthesiology, *72*(5), 458–465.
[23] Suzuki, M., Haraguti, S., Sugimoto, K., Kikutani, T., Shimada, Y., & Sakamoto, A. (2006). Low-dose intravenous ketamine potentiates epidural analgesia after thoracotomy. Anesthesiology, *105*(1), 111–119.
[24] Turkmen, K., Erdur, F. M., & Ozcicek, F. (2013). Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in patients with end-stage renal disease. Hemodialysis International, *17*(3), 391–396.
[25] Tzikos, G., Alexiou, I., & Tsagkaropoulos, S. (2023). Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictive factors for mortality and length of hospital stay after cardiac surgery. Journal of Personalized Medicine, *13*(3), 473.
[26] Vaughan-Shaw, P. G., Rees, J. R. E., & King, A. T. (2012). Neutrophil lymphocyte ratio as a predictor of outcome after emergency abdominal surgery in the elderly. International Journal of Surgery, *10*(3), 157–162.
[27] Walsh, S. R., Cook, E. J., Goulder, F., Justin, T. A., & Keeling, N. J. (2005). Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. Journal of Surgical Oncology, *91*(3), 181–184.
[28] Westerdijk, K., Simons, K. S., Zegers, M., Wever, P. C., Pickkers, P., & de Jager, C. P. C. (2019). The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the intensive care unit: A retrospective cohort study. PLoS One, *14*(2), e0212861.
[29] Yildirim, O. T., Aydin, F., Aydin, A. H., Dagtekin, E., Aksit, E., & Hasirci, S. H. (2018). The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are independent predictors of blood pressure variability. Journal of Hypertension, *36*(Suppl. 1), e12.
Medicinal, Psychological, and Health Research Journal (MPHRJ)
Volume 2, Issue 4
July and August 2026
Pages 306-316

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