Effects of alfentanil hydrochloride on cough and hemodynamics during induction of general anesthesia in daytime surgery

Li, Hui; Zhang, Haixia; Cheng, Zhijun; Jiang, Hui

doi:10.23736/s2724-5691.21.09341-2

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…In addition, bolus alfentanil administration also shows specific advantage in clinical anesthesia because of its relatively fewer adverse effects. Previous studies have shown hemodynamic fluctuation in patients during remifentanil anesthesia, whereas alfentanil is associated with a significantly lower incidence of respiratory depression and improved hemodynamic stability when compared with remifentanil, 31,32 and our present study showed that pretreatment with low-dose alfentanil did not cause intraoperative hemodynamic instability, suggesting the safety of this regimen.…”

Section: Discussionsupporting

confidence: 71%

Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study

Xu,

Zou,

et al. 2024

DDDT

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Background Cough is one of the most common complications following intravenous administration of sufentanil during anesthesia induction. The study aimed to investigate the protective effect of alfentanil, afentanyl derivative with short onset time and short duration, in reducing sufentanil-induced cough. Patients and methods Eighty patients that scheduled for thyroid surgery under general anesthesia were randomly divided into the alfentanil group and normal saline group, with 40 cases per group. Patients in the alfentanil group received intravenous administration of 2 μg/kg alfentanil prior to sufentanil injection during general anesthesia induction, while the same dose of normal saline was administered in the normal saline group. The outcomes measures included the incidence and severity of cough and common side effects of opioids following the administration of sufentanil during the induction of general anesthesia, intraoperative hemodynamics parameters and major adverse events during anesthesia recovery period. Results The incidence of cough within one minute after the injection of sufentanil during anesthesia induction was 40% in the normal saline group, and the pretreatment of alfentanil significantly reduced the incidence of sufentanil-induced cough to 5% (p < 0.05). Correspondingly, the patients in the alfentanil group had decreased severity of sufentanil-induced cough compared with the normal saline group (p < 0.05). No significant differences in the incidences of common side effects of opioids (dizziness, nausea and vomiting, chest tightness and respiratory depression) within one minute after sufentanil injection were found (p > 0.05). Furthermore, there were no significant differences between the two groups in intraoperative hemodynamic parameters, extubation time, or the incidences of emergence agitation, respiratory depression, delayed recovery from anesthesia and postoperative nausea and vomiting during Postanesthesia Care Unit stay (p > 0.05). Conclusion Pretreatment with low-dose alfentanil (2 μg/kg) effectively and safely reduced both the incidence and severity of sufentanil-induced cough during anesthesia induction. Clinical Trial Registration Number Chinese Clinical Trial Registry (identifier: ChiCTR2300069286).

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Section: Discussionsupporting

confidence: 71%

Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study

Xu,

Zou,

et al. 2024

DDDT

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“…[5] Alfentanil is a short-acting opioid with mild respiratory depression, low incidence of PONV and cough. [12,13] Langevin et al [14] found in a randomized controlled study that alfentanil caused less postoperative nausea and vomiting in outpatients compared to the same dose of fentanyl or sufentanil. It is recommended to combine sedatives for pain caused by short surgery.…”

Section: Discussionmentioning

confidence: 99%

Effect of low-dose propofol combined with dexamethasone on the prevention of postoperative nausea and vomiting in gynaecological day surgery under remimazolam-based general anesthesia

et al. 2023

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Background: To observe the effect of low-dose propofol combined with dexamethasone on the prevention of postoperative nausea and vomiting (PONV) in gynaecological day surgery under remimazolam-based general anesthesia.Methods: A total of 120 patients, aged from 18 to 65 years old, American Society of Anesthesiologists grade I or II, were scheduled to undergo hysteroscopy under total intravenous anesthesia. The patients were divided into 3 groups (n = 40 each): dexamethasone plus saline group (DC group), dexamethasone plus droperidol group (DD group) and dexamethasone plus propofol group (DP group). Dexamethasone 5 mg and flurbiprofen axetil 50 mg were given intravenously before induction of general anesthesia. Anesthesia induction: remimazolam 6 mg/kg/hours was continuously pumped until sleep and slow intravenous injection of alfentanil 20 ug/kg and mivacurium chloride 0.2 mg/kg was given. Anesthesia maintenance: remimazolam 1 mg/kg/ hour and alfentanil 40 ug/kg/hours were continuously pumped. After the start of surgery, DC group was given 2 mL saline, DD group was given droperidol 1 mg, and DP group was given propofol 20 mg. Primary outcome: incidence of PONV in the postanesthesia care unit (PACU). Secondary outcome: incidence of PONV in patients within 24 hours after surgery, as well as general patient data, duration of anesthesia, the recovery time of patients, dose of remimazolam and alfentanil, etc.Results: In PACU, patients of group DD and DP showed less PONV than those in group DC (P < .05). Within 24 hours after operation, there was no significant difference in the incidence of PONV among the 3 groups (P > .05), but the incidence of vomiting in DD group and DP group was significantly lower than that in DC group (P < .05). There was no significant difference in general data, anesthesia time, the recovery time of patients and dosage of remimazolam and alfentanil among the 3 groups (P > .05). Conclusion:The effect of low-dose propofol combined with dexamethasone to prevent PONV under remimazolam-based general anesthesia was similar to that of droperidol combined with dexamethasone, both of which significantly reduced the incidence of PONV in the PACU compared to dexamethasone alone. However, low-dose propofol combined with dexamethasone had little effect on the incidence of PONV within 24 hours compared to dexamethasone alone and only reduced the incidence of postoperative vomiting in patients.Abbreviations: ASA = American Society of Anesthesiologists, DD group = dexamethasone plus droperidol group, DC group = dexamethasone plus saline group, DP group = dexamethasone plus propofol group, PACU = postanesthesia care unit, PONV = postoperative nausea and vomiting.

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“…Drug synergy refers to the effect of a drug being promoted or increased with the use of other drugs [14]. The current short-acting anesthetics with good controllability make the total intravenous anesthesia technique one of the main methods of clinical anesthesia [15,16].…”

Section: Discussionmentioning

confidence: 99%

Effect of preinfusion of low-dose alfentanil on the induction of anesthesia with remimazolam in gynecological day surgery: a prospective, double-blind, randomized controlled study

Lu,

Qin,

Gao

et al. 2023

Preprint

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Purpose: Alfentanil has a synergistic sedative effect with benzodiazepines, and this study aimed to investigate the effect of preinfusion of low-dose alfentanil on the dose of remimazolam for loss of consciousness while observing the effect on hemodynamic changes and other adverse effects. Methods: Thirty-four gynecological day surgery patients were selected and randomly divided into the control group and the observation group; before anesthesia induction, both groups were given dexamethasone 5 mg, haloperidol 1 mg, and flurbiprofen ester 50 mg. Anesthesia induction: The control group was prefilled with 10 ml of saline, and remimazolam was pumped in rate of 6 mg/kg/h until consciousness disappeared; Micuronium chloride was injected slowly at 30 seconds, alfentanil 15 µg/kg was injected slowly at 30 seconds, and mechanical ventilation was carried out 2 minutes after placement of a laryngeal mask. In the observation group, first, 5µg/kg of alfentanil diluted to 10 ml was administered, remimazolam was pumped at rate of 6 mg/kg/h until consciousness disappeared, 0.2 mg/kg micuronium chloride was injected slowly for 30 seconds, 15 µg/kg alfentanil was injected slowly for 30 seconds, assisted ventilation was performed, a laryngeal mask was placed after 2 minutes, and mechanical ventilation was implemented. Anesthesia maintenance: remimazolam 1 mg/kg/h, alfentanil 40 µg/kg/h to maintain anesthesia, and micuronium chloride 0.05 mg/kg was given for more than 30 minutes of surgery; infusion of anesthetics was stopped at the end of surgery. The primary outcome was the dose of remimazolam for loss of consciousness; the secondary outcomes were the changes in hemodynamics during the induction period of anesthesia, and the incidence of adverse events such as hiccups and involuntary body movements during the induction period. Results: The dose of remimazolam for loss of consciousness in group A (13.14±2.51) mg was lower than that in group C (17.09±3.40) mg (p<0.05); the time to loss of consciousness in group A (123.81±21.08) s was lower than that in group C (156.80±30.67) s (p<0.05); the incidence rate of total adverse reactions in group A (12.5%) was lower than that in group C ( 46.6%); the heart rate of group A was slightly higher than that of group C (p=0.003), and there was no significant difference in MAP, SPO2 and BIS between the two groups (p>0.05). Conclusions: Preinfusion of a low dose of alfentanil significantly reduces the dose of remimazolam, causing loss of consciousness, speeds up induction, reduces the overall rate of adverse effects, and slightly increases heart rate.

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Effects of alfentanil hydrochloride on cough and hemodynamics during induction of general anesthesia in daytime surgery

Cited by 6 publications

References 5 publications

Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study

Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study

Effect of low-dose propofol combined with dexamethasone on the prevention of postoperative nausea and vomiting in gynaecological day surgery under remimazolam-based general anesthesia

Effect of preinfusion of low-dose alfentanil on the induction of anesthesia with remimazolam in gynecological day surgery: a prospective, double-blind, randomized controlled study

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