Probable Seizure after Alfentanil

Abstract

There have been several case reports of seizure-like activity associated with fentanyl (1-3) and sufentanil ( 6 6 ) during induction of anesthesia as well as postoperatively (7). As yet there have been no reports of such activity described with alfentanil. Case ReportA 60-year-old, 70-kg male was scheduled for an L P 5 laminectomyldiscectomy. He had a history of atherosclerotic heart disease with prior myocardial infarction in 1981 and stable angina. He also had a history of atherosclerotic peripheral vascular disease with prior abdominal aortic aneurysm repair in 1982. His medications included propranolol, dipyridamole, isosorbide, and diazepam. He had no prior history of a seizure disorder or other neurologic disease. Except for a slightly decreased left patellar tendon reflex and back tenderness, his physicaI examination was within normal limits.The patient was given his usual cardiac medications plus, one hour prior to surgery, metoclopramide 10 mg, ranitidine 150 mg and diazepam 5 mg. He also received 1 mg of midazolam iv just prior to entering the operating room. He was monitored with an EKG, an automated sphygmomanometer, a precordial stethoscope, and a pulse oximeter prior to, during, and after induction of the anesthesia. Following the preoxygenation, he was given 1500 Fg of alfentanil(25 pglkg) over 30 seconds. He developed a tremor in the right arm, and then in the left arm, followed by coarse jerking movements of both legs. The movement became progressively more rhythmic and coarse. Then his eyes rolled up and he became

Seizures in a 77‐year‐old‐woman after a bolus dose of remifentanil

“…Seizure-like events have been reported for all opioids of the fentanyl group (3)(4)(5). The effect of these opioids to induce activity in epileptogenic areas of the brain has been used to localize these during epilepsy surgery (6).…”

“…We have experienced seizures in a patient with no previous history of epilepsy after a 50-mg bolus dose of remifentanil. The ability to induce seizure-like events has previously been described for other opioids of the fentanyl group (3)(4)(5).…”

Alfentanil‐Induced Epileptiform Activity: A Simultaneous Surface and Depth Electroencephalographic Study in Complex Partial Epilepsy

“…Among their many medical applications, fentanyl and its congeners, sufentanil and alfentanil, are used both to assist in and to initiate the induction and maintenance of general anesthesia in patients undergoing surgery. Although several reports have described the onset of movements consistent with convulsive behavior by patients administered these drugs intravenously (5–10), scalp‐recorded electrographic confirmation of seizure activity has been ambiguous. The most dramatic EEG finding in patients observed to have had evidence of convulsive activity in response to these drugs has been generalized slowing without the presence of epileptiform activity (11–17).…”

Probable seizure after remifentanil in a 4‐year‐old boy

“…Opioid‐induced seizures have been reported previously [1, 2] although there is controversy regarding the true nature of seizure‐like activity following opioids. In one study [3] the EEG was recorded during administration of large doses of fentanyl, alfentanil or sufentanil and, despite a high incidence of muscle rigidity and myoclonic limb movements, no true epileptiform activity was noted.…”