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Time-Course of Respiratory Depression After an Alfentanil Infusion-Based Anesthetic

Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Abstract

Postoperative respiratory depression after alfentanil administration has been described in several case reports. The effects of a prolonged alfentanil infusion on the CO₂ response curve or cognitive function have not been studied. Twenty-one ASA physical status I or II patients were studied after a prolonged alfentanil infusion (>90 min) to determine the incidence of postoperative respiratory depression, arterial O₂ desaturation, and impairment of cognitive function. Each patient's recovery was observed at 30-min intervals for evidence of respiratory depression (utilizing the Read CO₂ rebreathing method), desaturation by pulse oximetry (severe desaturation defined as arterial O₂ saturation <90%), and cognitive function (utilizing Trieger dot and digit substitution tests). Plasma samples were also examined for secondary elevations in alfentanil plasma concentrations. Significant depression of the CO₂ response curve and cognitive function was found up to 1 h postoperatively. Arterial O₂ desaturation was seen in 11 of 21 patients (52%). No correlation was found between arterial O₂ desaturation and cognitive function scores or CO₂ rebreathing results. Increased depression of the CO₂ response curve was not necessarily associated with severe desaturation episodes. A secondary increase in plasma alfentanil concentration was detected in 5 of the 21 patients (24%), but these patients did not experience further depression of the CO₂response curve. We conclude that prolonged alfentanil administration may result in severe arterial O₂desaturation with significant depression of the hyper-capnic respiratory drive during the first hour in the postanesthesia care unit, even though the majority of our patients were easily aroused in response to verbal stimuli.

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