Alfentanil infusion for sedation in infants and small children during cardiac catheterization

Abstract

We have analyzed several sedation techniques for paediatric cardiac catheterization which offer stable conditions for a few hours investigation, and maintain spontaneous breathing. In the present study, after premedication with oral flunitrazepam 0.1 mg · kg-1, 14 children aged 1-17 mo were sedated with an individually titrated alfentanil infusion. Every patient was sedated to a level which produced no reaction to pain or any discomfort. The induction dose and the maintenance requirement of alfentanil were 24 ± 8 μg · kg- 1 and 32 ± 8 μg · kg- 1 · hr- 1 (mean ± SD), respectively. These doses were less in cyanotic than in acyanotic patients: 21 ± 6 vs 28 ± 8 μg · kg- 1 and 29 ± 10 vs 34 ± 3 μg · kg- 1 · hr- 1, respectively (P < 0.05). The mean plasma concentration of alfentanil during maintenance of sedation was 79 ± 23 ng · ml- 1. Ventilation of two children was assisted for a short time after an incremental bolus of alfentanil. It is concluded that an alfentanil infusion technique with close monitoring of breathing is a practical sedation method for paediatric cardiac catheterization. © 1991 Canadian Anesthesiologists.