Ventilatory Depression During and after Infusions of Fentanyl and Alfentanyl in Man

Andrews, Christopher J.; Sinclair, M; A, Dye; Dye, J.; Harvey, J.; Prys‐Roberts, C.

doi:10.1007/978-3-642-69355-7_49

Cited by 16 publications

(17 citation statements)

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“…Four different maintenance protocols were used: isoflurane (Isoflurane, Merial Italy) (n = 20) (group I), isoflurane with CRI of propofol at 0.1 mg kg −1 min −1 (n = 20) (group IP) [29], [30], [31], isoflurane with CRI of fentanyl (Fentanyl, Janssen-Cilag Greece) at 0.2 µg kg −1 min −1 (n = 20) (group IF) [32], [33], and isoflurane with CRI of ketamine (Imalgene 1000, Merial Italy) at 0.2 mg kg −1 min −1 (n = 20) (group IK) [30]. In group IK, midazolam (Dormicum, Roche Greece) at 0.3 mg kg −1 was also administered intravenously, just after the end of the ketamine CRI and, irrespective of the duration of the surgery, after the end of P di measurements.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Four Anaesthetic Protocols for Maintenance of Anaesthesia on Trans-Diaphragmatic Pressure in Dogs

et al. 2013

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The diaphragm is the main inspiratory muscle and the main indicator of diaphragmatic contractility is the trans-diaphragmatic pressure (Pdi). The aim of this clinical study was to determine the effect of four different anaesthetic protocols on Pdi in anaesthetized healthy dogs. Eighty client-owned dogs were recruited in this clinical study. All the animals received dexmedetomidine and morphine as premedication and propofol for induction. Anaesthesia was maintained with one of four protocols: isoflurane (I), isoflurane with CRI of propofol (IP), isoflurane with CRI of fentanyl (IF), and isoflurane with CRI of ketamine (IK). When the surgical plane of anaesthesia was achieved, two balloon catheters were inserted, one into the stomach and one into the mid-third of the oesophagus for Pdi measurement. Pdi value was the highest in groups I (14.9±4.7 mmHg) and IK (15.2±3.5 mmHg) and the lowest in groups IP (12.2±3.2 mmHg) and IF (12.0±5.9 mmHg). There was a statistically significant difference (p = 0.029) between groups IK and IF. PE’CO2 was statistically significantly higher (p<0.0005) in group IF (7.7±0.8 kPa) than in group IK (6.5±0.7 kPa). Isoflurane alone or isoflurane with ketamine for the maintenance of anaesthesia seem to better preserve the respiratory function and the diaphragmatic contractility than isoflurane with either propofol or fentanyl in dogs. Therefore, the use of isoflurane or isoflurane with ketamine may be of benefit when animals with respiratory problems have to be anaesthetized.

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Section: Methodsmentioning

confidence: 99%

The Effect of Four Anaesthetic Protocols for Maintenance of Anaesthesia on Trans-Diaphragmatic Pressure in Dogs

et al. 2013

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“…These agents also reduce the requirement for intravenous hypnotics or inhalational agents. However, since traditional opioids accumulate in the body over time, the optimal use of opioids in these techniques is often limited by side-effects, such as delayed or recurrent ventilatory depression, which can delay postoperative recovery [2,3]. Moreover, since traditional opioids are metabolised by the liver, they must be used with caution in patients with hepatic insufficiency [4,5].…”

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confidence: 99%

A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery

et al. 1997

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SummaryThe efficacy and safety of remifentanil and alfentanil for patients undergoing major abdominal surgery were compared. Premedicated patients received a loading dose of remifentanil (1.0 mg.kg ¹1 ; n ¼ 116) and a continuous infusion of 0.5 mg.kg ¹1 .min ¹1 , or a loading dose of alfentanil (25 mg.kg ¹1 ; n ¼ 118) and a continuous infusion of 1.0 mg.kg ¹1 .min ¹1 . Propofol was administered (10 mg every 10 s) until loss of consciousness. Patients' lungs were ventilated with 66% nitrous oxide and 0.5% (end-tidal) isoflurane in oxygen. The study drug infusion rate was reduced by 50% 5 min after intubation. Alfentanil was discontinued 15 min before the end of surgery, whereas remifentanil was continued in the immediate postoperative period at a reduced dose. Responses to intubation (28%) and skin incision (17%) occurred approximately twice as often in the alfentanil group (15% and 8%; p ¼ 0.014 and p ¼ 0.037, respectively). More patients receiving alfentanil had one or more responses to surgery (72% vs. 57%; p ¼ 0.016). The time to spontaneous respiration, adequate respiration, response to verbal command and time to recovery room discharge were similar. However, owing to decreased variability, the time to extubation was shorter with remifentanil than with alfentanil (p ¼ 0.048). There was a similar overall incidence of adverse events in both groups, 82% and 75% of patients, respectively. Adverse events associated with remifentanil were rapidly controlled by dose reductions. The incidence of intra-operative hypotension and bradycardia was higher in the remifentanil group (p Յ 0.033). An initial remifentanil infusion rate of 0.1 mg.kg ¹1 .min ¹1 titrated to individual need provided postoperative pain relief in the presence of adequate respiration in 71% of patients. When using remifentanil in the immediate postoperative setting, rapid administration of bolus doses and infusion rate increases resulted in a relatively high incidence of muscle rigidity, respiratory depression and apnoea. Changing the postoperative regimen to avoid rapid changes in remifentanil blood concentration resulted in more effective analgesia and dramatically reduced the incidence of adverse events during this period. In patients undergoing major abdominal surgery, remifentanil appears to offer superior intra-operative haemodynamic stability during stressful surgical events compared with alfentanil without compromising recovery from anaesthesia. Remifentanil can be administered as a postoperative analgesic agent at a starting dose of 0.1 mg.kg ¹1 .min ¹1 ; however, it should only be used in the presence of adequate supervision and monitoring of the patient. Administration of bolus doses is not recommended in this setting.

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“…In common with other opiates, alfentanil produces respiratory depression which has been shown to be comparable to that produced by fentanyl (Andrews et al 1983), although recovery is, predictably, faster. The cardiovascular effects of alfentanil have been compared with those of fentanyl in anaesthetised patients (Rucquoi & Camu 1983).…”

Section: Clinical Pharmacology Of Alfentanilmentioning

confidence: 94%

Alfentanil Infusions in Patients Requiring Intensive Care

Bodenham

Park

1988

Clinical Pharmacokinetics

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Alfentanil is a short acting opioid that has an established place in anaesthesia. Its predictable pharmacokinetics and pharmacodynamics, particularly its rapid termination of effect and haemodynamic stability, have led to its use by continuous intravenous infusion both during anaesthesia and more recently in critically ill patients. Fine control of a potent analgesic that has respiratory depressant and antitussive properties would be particularly advantageous in this group, offering patients an improvement in comfort without increasing the risk of oversedation. Pharmacokinetic studies of alfentanil have demonstrated wide interindividual variations. This may be due to a wide variety of factors including age, obesity, hepatic dysfunction, changes in regional haemodynamics, sex, and alterations in plasma protein binding ability and concentration. The importance of pharmacogenetic differences and tolerance to alfentanil remains to be elucidated. Renal disease does not appear to significantly alter the pharmacokinetics of this agent, which may make it particularly useful in this situation. Since alfentanil does not depress conscious level or produce anxiolysis, additional agents such as a benzodiazepine will be necessary to provide adequate sedation. The difficulties in accurately predicting the response of an individual critically ill patient necessitate careful and continuous dose titration of alfentanil according to the clinical response.

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Ventilatory Depression During and after Infusions of Fentanyl and Alfentanyl in Man

Cited by 16 publications

References 0 publications

The Effect of Four Anaesthetic Protocols for Maintenance of Anaesthesia on Trans-Diaphragmatic Pressure in Dogs

The Effect of Four Anaesthetic Protocols for Maintenance of Anaesthesia on Trans-Diaphragmatic Pressure in Dogs

A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery

Alfentanil Infusions in Patients Requiring Intensive Care

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