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Anesthetic Induction with Alfentanil
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1982
Year
Adult Cardiac SurgeryCardiac AnaesthesiaPerioperative MedicineNon-operating Room AnesthesiaAnalgesiaHalothane-nitrous Oxide AnesthesiaAnesthetic AdministrationCardiovascular DynamicsCardiologyCardiothoracic SurgeryAnesthesia PracticeAnaesthetic AgentAnesthetic InductionCardiovascular DiseasePatient SafetyThoracic SurgeryAnesthesiaMedicineChest Wall RigidityAnesthesiology
Alfentanil, a new ultra short-acting, potent, synthetic narcotic was evaluated as an anesthetic induction agent in 20 unsedated, patients premedicated with atropine about to undergo general surgical operations with halothane-nitrous oxide anesthesia (group I) and in 22 patients premedicated with lorazepam and atropine [nine with mitral valvular disease (group II), and 13 with coronary artery disease (group III)], about to undergo open-heart surgery with alfentanil-oxygen anesthesia. Patients in groups II and III had radial and thermodilution pulmonary arterial catheters in place before anesthetic induction. Following pretreatment with pancuronium (1.5 mg/70 kg) and while breathing pure oxygen, alfentanil was administered intravenously at a rate of 50 μg/kg/min until the patient was unconscious. Cardiovascular dynamics were measured before and after pancuronium, at the point of unconsciousness, following succinylcholine paralysis, and 1 and 4 minutes after endotracheal intubation. The time of induction and the incidence of arrhythmias, chest wall rigidity, and pain on injection were also recorded. Loss of consciousness was rapid, 134 ± 28, 47 ± 19, and 75 ± 22 seconds in groups I, II, and III, respectively. Alfentanil resulted in a transient small decrease in systolic arterial blood pressure with loss of consciousness in groups II and III but no change in right atrial and mean pulmonary arterial pressures or cardiac output throughout the study period. Patients in group I had no change in any cardiovascular variable measured. The only significant undesirable side effect was chest wall rigidity, which occurred in 50% of group I and 22% and 31 % of groups II and III, respectively. No patient remembered any aspect of laryngoscopy, endotracheal intubation, or surgery and only one thought the anesthetic induction was unpleasant. These data indicate that rapid infusion with alfentanil results in a rapid, pleasant anesthetic induction with little change in cardiovascular dynamics and a minimum of side effects.