Fentanyls continue to replace heroin in the drug arena: the cases of ocfentanil and carfentanil Ocfentanil and carfentanil are two potent synthetic opioids that are analogues of fentanyl and are actively involved in the recent fentanyl crisis. The aim of this review is to provide all the available information on these two fentanyl analogues. All reviewed information was gathered through a detailed search of PubMed and the World Wide Web using relevant keywords. Like most of the members of the family of fentanyls, they are either sold as heroin to unsuspecting users or used extensively to lace heroin street samples. Despite the fact that ocfentanil was studied clinically in the early 1990s, it did not manage to find its place in clinical practice. On the other hand, carfentanil is mainly
. The review is focused on fentanyl and derivatives (e.g., acetyl fentanyl, butyryl fentanyl, carfentanil, furanyl fentanyl, 4-methoxybutyrylfentanyl, 4-fluorobutyrylfentanyl, ocfentanil) and non-traditional opioid agonists (e.g., AH-7921, MT-45, U-47700). All of these data are critically compared to postmortem data, and chemical and pharmacological properties of natural opioids (morphine), semi-synthetic
, tetrahydrofuranylfentanyl, cyclopentylfentanyl, and ocfentanil) and compounds with different chemical structures, such as AH-7921, MT-45, and U-47700. This survey provides an overview of the pharmacological properties, pattern of use, and desired and unwanted effects of the above-listed novel opioids. Special emphasis is given to cases of non-fatal and lethal intoxication involving these compounds.
Comparison of ocfentanil and fentanyl as supplements to general anesthesia. Three doses of ocfentanil (1, 3, and 5 micrograms/kg), a new narcotic, were compared with fentanyl (5 micrograms/kg) as a supplement to general anesthesia. Sixty adult ASA I-III patients undergoing elective surgery were studied. The drugs were given as a bolus injection during induction of anesthesia in a double-blind manner. With the stimulus of tracheal intubation, systolic arterial blood pressure increased (mean +/- SE) from 127 +/- 6.9 to 183 +/- 7.4 mm Hg and heart rate increased from 82.1 +/- 4.8 to 104 +/- 6.4 beats/min in patients who had received 1 microgram/kg of ocfentanil intravenously. In comparison to patients who received 1 microgram/kg of ocfentanil, the increases in heart rate and systolic arterial