A Comparison of Effects of Alfentanil, Fentanyl, and Remifentanil on Hemodynamic and Respiratory Parameters During Stereotactic Brain Biopsy

Abstract

The aim of this study was to compare the effects of 3 different sedative-analgesic regimens in patients with intracranial mass lesions undergoing stereotactic brain biopsy. A 135 outpatients with American Society of Anesthesiologists I to II were divided into 3 groups: group A (n = 45) received a loading dose of IV alfentanil 7.5 microg/kg followed by infusion rate of 0.25 microg/kg/min; group F (n = 45) received a bolus dose of 1 microg/kg IV fentanyl and repeated as needed; and group R (n = 45) received infusion of 0.05 microg/kg/min remifentanil. Target level of sedation was 3 to 4 of the Ramsay Sedation Scale. Systolic and diastolic blood pressure, heart rate, respiratory rate, peripheric oxygen saturation (SpO2), and end-tidal carbon dioxide were recorded at different stages of the procedures. The patients in group F had significantly lower mean heart rate than those in groups A and R, but this was not in the limits of the bradycardia. The patients in group A had significantly lower mean SpO2 than those in the other groups, but mean SpO2 values did not drop below 94%. There were no significant differences in end-tidal carbon dioxide and respiratory rate values among the groups. Our results suggest that all 3 regimens have relatively similar hemodynamic and respiratory responses. The use of bolus fentanyl technique caused less hemodynamic stability. The continuous infusion technique of remifentanil or alfentanil provided better control on hemodynamic parameters.

Rescue treatment for noninvasive ventilation failure due to interface intolerance with remifentanil analgosedation: a pilot study

“…Different physiological studies on the effects of analgesia-based sedation on ventilatory response [6,7,14] suggest that a continuous infusion of new generation opioids may be used as a single sedative agent, allowing patient discomfort to be mitigated and the desired level of awake sedation to be obtained with no significant effects on respiratory drive, minute volume, respiratory pattern, blood gases, and hemodynamics. These data are fully confirmed by our experience, where no patient had respiratory drive or hemodynamic alterations during the study period.…”

Remifentanil and Other Opioids

“…This is probably related to the very rapid onset of effect the drug (Nieuwenhuijs et al 2003;Habib et al 2002;Dimitriou et al 2006;Lecomte et al 2006;Bilgin et al 2006;Chanavaz et al 2005;Locala et al 2005;Pleym et al 2004;Ouattara et al 2004;Godet et al 2004;Heijmans et al 2004;Joo et al 2004;Unlugenc et al 2003;Jellish et al 2003;Manyam et al 2006;Albertin et al 2006;Mustola et al 2005;Albertin et al 2004;Bouillon et al 2004;Kern et al 2004;Drover et al 2004;Mertens et al 2003;Milne et al 2003;Fechner et al 2003;Criado and Gomez e Segura 2003;Bothtner et al 2002).…”

Anesthesia in the patient for awake craniotomy

“…Other authors compared the effects of alfentanil, fentanyl and remifentanil on the hemodynamic parameters of 135 patients undergoing sedative analgesic regimes for stereotactic brain biopsies [11 ] All three techniques had similar hemodynamic and respiratory responses, but bolus fentanyl resulted in less hemodynamic stability than infusion techniques with remifentanil and alfentanil.…”