Effects of Alfentanil on the Hemodynamic and Catecholamine Response to Tracheal Intubation

Abstract

A randomized, placebo-controlled study was conducted in 60 ASA Class I, II, and III patients to determine the dose response of alfentanil in moderating the cardiovascular and catecholamine response to tracheal intubation (INT). Patients were randomly allocated into one of four groups to receive either 15 micrograms/kg alfentanil (A15), 30 micrograms/kg alfentanil (A30), 45 micrograms/kg alfentanil (A45), or normal saline (control), given intravenously (i.v.) before induction of anesthesia. One minute after administration of 4.0 mg/kg thiopental and 1.5 mg/kg succinylcholine i.v., tracheal intubation was performed using direct laryngoscopy. In response to INT, increases in heart rate, systolic blood pressure, and systemic vascular resistance occurred in the control group. These changes were significantly more than corresponding changes of heart rate, systolic blood pressure, and systemic vascular resistance in all three alfentanil groups (P < 0.05). In contrast, cardiac index and ejection fraction decreased moderately in every group during the study period, but there were no differences among groups with respect to either cardiac index or ejection fraction at corresponding times following INT. In the control group, epinephrine and norepinephrine serum concentrations increased by 152 +/- 52% and 58 +/- 62%, respectively, following INT (different from A30 and A45, P < 0.05). However, up to a dose of 30 micrograms/kg (A30), a dose-dependent decrease in the maximum percent changes of both epinephrine and norepinephrine occurred in response to INT. A larger dose of alfentanil was no more efficacious as the catecholamine response to tracheal intubation was not significantly different when comparing the A45 and A30 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

“…The combination of alfentanil 30 mg/kg with thiopentone 4 mg/kg and succinylcholine 1.5 mg/kg provided complete attenuation of the haemodynamic response to intubation 118,119 [II]. Increasing the dose of Alfentanil to 45 or 60 mg/kg resulted in transient but significant decreases in the heart rate and the mean arterial pressure.…”

Assessment of efficacy of intravenous fentanyl citrate for attenuation of hemodynamic responses during laryngoscopy and endotracheal intubation

“…These included epinhalational anaesthesia, deep intravenous general anaesthesia, topical anaesthesia with lignocaine, drugs like anti hypertensives, beta adrenoreceptor antagonists (propranolol, metoprolol, esmolol, 2 labetolol), Gabapentine, 3 peripheral vasodilators, intravenous lignocainelignocaine aerosol 4,5 Angiotension converting enzyme blockers,Magnesiumsulphate, 6 alpha2 agonist ( Dexmedetomidine, 7 Clonidine 8 ), Droperial, intravenous Ketorolac, Nitroglycerine ointment, Calcium channel blocker, Buprenorphine, Fentanyl [9][10][11][12][13] and Alfentanil. [14][15][16] During laryngoscopy and intubation, fentanyl, µ receptor agonist is a natural choice to attenuate pressor response. 17 Low dose fentanyl decreases the circulatory response to tracheal intubation, reduces the dose of thiopentone, has rapid onset of action, extremely lipid soluble, provides cardiovascular stability throughout the operative period, blocks sympathetic stress response to surgical stimulation, rapid and potent analgesic, anxiolytic and sedative and decreases the concentration of inhaled agent requirement.…”

Comparative effects of propofol, landiolol, and nicardipine on hemodynamic and bispectral index responses to endotracheal intubation: a prospective, randomized, double-blinded study

“…However, no data exist regarding the effects of additional propofol doses given before intubation on hemodynamic changes and BIS in the postintubation period. Recently, noninvasive cardiac index (CI) monitors have become available for continuous measurement of beat-to-beat stroke volume (SV) with impedance cardiography [12,13].…”