Advantages and disadvantages of combining alfentanil with volatile anesthetics

Abstract

Methods. Three randomized groups of patients scheduled for upper abdominal surgery received either an initial large bolus of alfentanil combined with low concentrations of isoflurane (group 1), and initial small bolus of alfentanil combined with 50% higher isoflurane concentrations than group 1 (group 2), or isoflurane without opioids (group 3). Blood pressure, heart rates, and anesthetic consumptions were measured and recorded, as were side-effects such as thoracic rigidity, bradycardia, and nauseau, and postoperative recovery time. Results. The mean isoflurane concentrations in group 1 was 0.8 vol% combined with an average alfentanil bolus of 6.8 mg and three additional doses of 1.1-1.4 mg. Group 2 received a mean isoflurane concentration of 1.3 vol% combined with four additional doses of 1.3-1.7 mg alfentanil. Group 3 needed an average isoflurane concentration of 1.5 vol%. Side effects of alfentanil were prevented by atropine administration; severe complications were not observed. Postoperative recovery time showed significant differences between groups 1 and 2: group 1 patients were awake within 7.5 min and group 2 within 17 min after the operation. No respiratory depression was detected. Conclusions. Alfentanil combined with volatile anesthetics produced no severe side-effects in patients scheduled for upper abdominal operations. The pharmakokinetics of alfentanil are advantageous with regard to the postoperative period.