Modification by alfentanil of the haemodynamic response to tracheal intubation in elderly patients: A dose-response study

Abstract

Fifty-five elderly patients undergoing elective ophthalmological surgery were randomly allocated to four groups. Following the induction of anaesthesia with thiopentone (given over 2 min) and the administration of atracurium 0.6 mg kg-1, patients received alfentanii 400, 600, 800 or 1000 μg. Intubation of the trachea was performed 90 s later. Heart rate was monitored continuously and systolic arterial pressure was measured at 1-min intervals for 3 min before induction, and both variables were monitored until 10 min had elapsed after tracheal intubation. In each of the groups there was a significant decrease in systolic arterial pressure and a significant increase in heart rate on induction of anaesthesia. In those patients who received either 400 or 600 μg of alfentanii, arterial pressure increased immediately after tracheal intubation, whereas in those receiving alfentanii 800 or 1000 μg, arterial pressure decreased immediately after tracheal intubation, and when measured 10 min after intubation. It is suggested that alfentanil 600 μg (10 μg kg-1) constitutes the optimal dose with which to obtund the haemodynamic response to tracheal intubation in elderly patients, and to minimize cardiovascular depression after tracheal intubation. © 1988 British Journal of Anaesthesia.