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Paul Janssen produced the first commercially available fentanyl powder in 1960, a few years after pethidine (also called meperidine, sold as Demerol) was initially used in medicine. By testing analogs of the structurally similar medication pethidine for opioid action, Janssen created fentanyl. Fentanyl citrate, which is the salt that is created when fentanyl and citric acid are combined in a 1:1 stoichiometry, was produced as a result of the extensive usage of fentanyl. It was first used in medicine as a general anesthetic in the 1960s under the brand name Sublimaze. Many more fentanyl analogs, including as sufentanil, alfentanil, remifentanil, and lofentanil, were thereafter created and used in medicine.