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Variable Rate Infusion of Alfentanil as a Supplement to Nitrous Oxide Anesthesia for General Surgery

Department of Anaesthesia, University of Leiden Hospital, Leiden, The Netherlands.

Abstract

In this study we attempted to define the minimal dosage of alfentanil (AF) needed in combination with nitrous oxide to provide satisfactory anesthetic conditions for lower abdominal gynecologic surgery. General anesthesia was induced in 12 women with AF (150 µg·kg^–1) and 66% N₂O in O₂. An infusion of AF was started immediately after the AF induction dose and was varied between 25–150 µg·kg^–1·hr^–1 as indicated by the patient's responses to stimulation during operations lasting 208 ± 22 (SEM) min. Small bolus doses of AF (7 µg·kg^–1) were administered to rapidly suppress precisely defined somatic, hemodynamic, and other sympathetic responses to stimulation. With one exception, all responses in all patients were controlled rapidly by increments of AF. The mean dosages of AF needed during different stages of surgery are reported. The AF infusion was stopped 16.2 ± 1.2 min before discontinuing N₂O. Recovery of consciousness along with satisfactory spontaneous ventilation occurred promptly after completion of the operation (4.0 ± 0.5 min after N₂O; 20.3 ± 1.4 min after stopping AF infusion). This study demonstrates the feasibility of maintaining general anesthesia with N₂O and a continuous AF infusion at a rate varied according to the patient's responses and allowing for prompt recovery of consciousness and satisfactory spontaneous ventilation at the conclusion of operations lasting as long as 5 hr.

Key Words: ANALGESICS: alfentanil

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999