BACKGROUND: Alfentanil has been shown to act synergistically if combined with propofol, with or without nitrous oxide, or if combined with potent inhalation anesthetics. The goal of this study was to determine the dosing rate and target plasma concentration of propofol to supplement nitrous oxide in the presence of varying concentrations of alfentanil and to determine the optimal combination of propofol and alfentanil. METHODS: Sixty patients undergoing a total abdominal hysterectomy (TAH) were anesthetized with nitrous oxide, and given a target-controlled infusion (TCI) of alfentanil [target plasma concentrations of 0 (A0 group), 50 ng/ml (A50 group), and 100 ng/ml (A100 group)], and propofol at rates varied up and down depending on the bispectal index (BIS). The mean target concentration (Tc) and infusion rate of propofol according to changes of concentrations of alfentanil were determined. Recovery time (from infusion stop to eye opening) and side effects were compared. RESULTS: Induction time and recovery time were shortened in the A50 group and A100 group compared with the A0 group (P < 0.05). The infusion rate and mean target concentration of propofol were significantly lower in the A100 group (7.5 mg/kg/h, 3.4ng/ml) than the A0 (12.6 mg/kg/h, 4.5ng/ml) and A50 (10.2 mg/kg/h, 4.0ng/ml) groups (P < 0.01). Side effects did not differ among the three groups. CONCLUSIONS: The optimal blood propofol and plasma alfentanil concentration, with respect to satisfactory intraoperative anesthetic conditions and speed of recovery, are 4.0ng/ml and 50 ng/ml or 3.4ng/ ml and 100 ng/ml in TAH patients.
Alfentanil* ; Anesthetics, Inhalation ; Humans ; Hysterectomy* ; Nitrous Oxide ; Plasma ; Propofol*

BACKGROUND: The administration of short-acting opioids before emergence is useful for preventing emergence cough induced by an endotracheal tube. This study examined the clinically effective dose of alfentanil for suppressing cough during emergence from desflurane anesthesia. METHODS: Twenty-nine adult patients undergoing elective oral surgery were enrolled in this study. During emergence from anesthesia, the patients received alfentanil diluted in 10 ml normal saline when the end-tidal vol% of desflurane decreased to 3%. The initial alfentanil dose was 16 microg/kg. The alfentanil dose for consecutive patients, determined by Dixon's up-and-down method, increased or decreased by 2 microg/kg according to a previous patient's result. RESULTS: The 50% effective dose (ED50) of alfentanil for suppressing cough during emergence from desflurane anaesthesia was 9.3 +/- 1.5 microg/kg according to Dixon's up-and-down method. Isotonic regression revealed an ED50 and ED95 (95% confidence interval) of alfentanil 10.0 microg/kg (6.8-13.2 microg/kg) and 14.0 microg/kg (7.7-19.4 microg/kg), respectively. CONCLUSIONS: The ED95 of alfentanil for suppressing emergence cough was 14.0 microg/kg. A single bolus administration of alfentanil during emergence from anesthesia was useful for suppressing emergence cough.
Adult ; Alfentanil ; Analgesics, Opioid ; Anesthesia ; Cough ; Humans ; Isoflurane ; Surgery, Oral

BACKGROUND: Intraoperative alfentanil is known to increase the epileptic discharge in the adult seizure patients. This study hypothesized that alfentanil might localize an epileptogenic focus in pediatric seizure patients. METHODS: This study was performed in the pediatric seizure patients who undergo second-staged operation. Thirteen pediatric patients were enrolled and their epileptic foci were already suspected from first operation. After anesthetic induction, sevoflurane was maintained at 0.6% end-tidal concentration for study period. Electrocorticography (ECoG) was recorded for 5 minutes before and 5 minutes after alfentanil 20microgram/kg IV. During the ECoG recordings, the mean arterial pressure (MAP) and heart rate (HR) were continuously monitored. After the surgery, a pediatric neurologist analyzed the changes of spike frequencies of suspected ictal zone. The spike frequencies of suspected non-ictal zone were also calculated in five patients. The suspected ictal zone was defined as the most abundant spontaneous spiking area observed after first staged grid insertion. RESULTS: Alfentanil induced a significant increase in spike activity of suspected ictal zone in 12 out of 13 patients (median of 20 [ranged 10 to 100] vs 38 [ranged 20 to 100], P< 0.05). Alfentanil-induced increase of spike activity was prominent in the suspected ictal zone rather than non-ictal zone. There were no significant changes in the MAP and HR after administration of alfentanil. CONCLUSIONS: Alfentanil activates epileptiform activity of suspected ictal zone in pediatric patients with seizure disorder and can be used to assist in the localization of the epileptogenic focus during seizure surgery.
Adult ; Alfentanil* ; Arterial Pressure ; Epilepsy* ; Heart Rate ; Humans ; Seizures*

BACKGROUND: We performed a prospective, randomized, controlled trial to compare the quality, hemodynamic response, and recovery index of laryngeal mask airway (LMA) insertion after either propofol alone or co-administration of alfentanil-propofol anesthesia. METHODS: Sixty patients (ASA 1 or 2, 17-63 years) were randomly allocated to control and experimental group. Control group(Group I) was received placebo (saline), experimental groups were received alfentanil 10microgram/kg (Group II), 20microgram/kg (Group III), 30microgram/kg (Group IV). RESULTS: Loss of consciousness and LMA insertion were more rapid in patients with alfentanil 30 microgram/kg group than control group (P<0.05). In alfentanil 20microgram/kg group, loss of consciousness was more rapid than control group. Also, there were significant differences in propofol induction dose, effect site concentration on induction, and propofol maintenance dose between control and experimental group (P<0.05). CONCLUSIONS: We conclude that co-adminstration of alfentanil-propofol, especially 30microgram/kg group, compares favorably with propofol alone, although LMA removal time is prolonged.
Alfentanil ; Anesthesia ; Hemodynamics ; Humans ; Laryngeal Masks* ; Propofol* ; Prospective Studies ; Unconsciousness

BACKGROUND: The aim of this randomized double-blinded study was to determine the optimal concentration of alfentanil with 0.15% ropivacaine for postoperative patient-controlled epidural analgesia. METHODS: Forty five patients undergoing major abdominal surgery under general anesthesia were assigned to groups receiving patient-controlled thoracic epidural analgesia with 0.15% ropivacaine + 45 microgram/ml alfentanil (Group I), 75microgram/ml alfentanil (Group II), 150 microgram/ml alfentanil (Group III). The incidence of side effects and additional analgesic use, VAS (visual analog pain scale) on resting and coughing, and patient's satisfaction were checked for 24 hours after a loading dose injection. RESULTS: The VAS on coughing and resting 1 hour after the loading dose injection were significantly lower in Groups II and III than in Group I. The patients in group II were more satisfied with the result than those in Group I. CONCLUSIONS: A combination of 0.15% ropivacaine and 75microgram/ml alfentanil for thoracic epidural analgesia after major abdominal surgery provides the best analgesia with minimal side effects and a higher level of patient's satisfaction.
Alfentanil* ; Analgesia ; Analgesia, Epidural* ; Anesthesia, General ; Cough ; Humans ; Incidence

BACKGROUND: The lower levels of cardiotoxicity and motor block make ropivacaine well suited as an epidural infusion for postoperative analgesia. This study examined the analgesic efficacy of an epidural infusion of ropivacaine alone and in combination with alfentanil after major abdominal surgery. METHODS: Thirty patients undergoing major abdominal surgery under general anesthesia were divided into two groups receiving patient-controlled thoracic epidural analgesia with 0.2% ropivacaine (Group I) and 0.15% ropivacaine +150 microgram/ml alfentanil (Group II). The motor block, side effects, VAS (visual analog pain scale) score on coughing and resting, additional analgesics use, and patient's satisfaction were checked for 24 hours after a loading dose injection. RESULTS: The VAS score in group II was significantly lower than in group I, and the patients in group II were more satisfied than those in group I (P < 0.05). However, there were more side effects in group II. CONCLUSIONS: Postoperative epidural infusion of 0.15% ropivacaine with 150 microgram/ml alfentanil is more effective than 0.2% ropivacaine only.
Alfentanil* ; Analgesia* ; Analgesia, Epidural ; Analgesics ; Anesthesia, General ; Cough ; Humans

BACKGROUND: The use of lipid soluble opioids such as fentanyl, alfentanil and sufentanil are recently on the increase for patient-controlled epidural analgesia (PCEA). In this study, the effects and adequate dose of sufentanil in arthroplasty were investigated. METHODS: Eighty patients scheduled for arthroplasty were enrolled for the study. Seventy-one patients (ASA physical status I-III) were randomly allocated into four groups. All groups received 0.1% ropivacaine through PCEA and each group received either fentanyl (group F: fentanyl 4 microg/ml) or sufentanil (group S1: sufentanil 0.5 microg/ml, group S2: sufentanil 0.75 microg/ml, and group S3: sufentanil 1.0 microg/ml). Postoperative pain scores were evaluated using VAS (visual analog scale, 0-10) and side effects such as hypotension, nausea/vomiting, pruritus and the degree of satisfaction were evaluated at 1, 6, 12, 24, 48 hours after surgery. RESULTS: Postoperative pain score (VAS) decreased gradually and the highest VAS score was recorded at 1 hour postoperative for all four groups. There were no differences in the degree of satisfaction and postoperative pain score between all groups. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3. CONCLUSIONS: The incidence of side effects were significantly lower in group S1 (0.1% ropivacaine plus sufentanil 0.5 microg/ml). Therefore, 0.5 microg/ml of sufentanil through PCEA is the recommended dose for postoperative pain control in arthroplasty.
Alfentanil ; Amides ; Analgesia, Epidural ; Analgesics, Opioid ; Arthroplasty ; Fentanyl ; Humans ; Hypotension ; Incidence ; Pain, Postoperative ; Pruritus ; Sufentanil

Tracheotomy and end-to-end anastomosis is a relatively rare operation, but it is one of the most challenging for anesthesiologists. During surgery, the principal anesthetic consideration is to maintain the ventilation and oxygenation throughout the procedure. We experienced anesthetic management of a 49-year-old man with upper tracheal stenosis after long-term intubation and ventilation care. The stenotic lesion was located at 2 cm below the vocal cords, and the length of the stenotic segment was about 2 cm. The anesthesia was induced and maintained with intravenous propofol and alfentanil. The airway was managed with LMA and distal tracheal intubation on the surgical field and we were able to maintain adequate ventilation and oxygenation throughout the operational period.
Alfentanil ; Anesthesia ; Humans ; Intubation ; Laryngeal Masks* ; Middle Aged ; Oxygen ; Propofol ; Tracheal Stenosis* ; Tracheotomy* ; Ventilation ; Vocal Cords

BACKGROUND: Propofol and alfentanil are frequently combined to provide total intravenous anesthesia (TIVA). The goals of this study were to determine the target plasma concentration (predicted plasma concentration) of propofol required to provide satisfactory anesthesia in the presence of nitrous oxide over a range of alfentanil infusions for analgesia and to determine the dosing rates required to achieve adequate anesthesia. METHODS: Sixty patients undergoing plastic surgery were anesthetized with 50% nitrous oxide, alfentanil (0 [A0 group] or 5ng/kg loading followed by 0.12ng/kg/min [A5 group] or 10ng/kg loading followed by 0.25ng/kg/min [A10 group] or 20ng/kg loading followed by 0.5ng/kg/min [A20 group]) and propofol using a target-controlled infusion (TCI). The mean target concentration and infusion rate of propofol, and induction and recovery time according to changes of the alfentanil regimen were checked. RESULTS: Induction and recovery time were prolonged in the A0 group more than other groups, and recovery time was shortened in the A10 group more than the other three groups (P < 0.05). The infusion rate and mean target concentration of propofol had significant impact among the groups (P < 0.05). Side effects did not differ among the groups. CONCLUSIONS: The optimal target plasma propofol concentrations and infusion rates of alfentanil, both with satisfactory intraoperative anesthetic conditions and speed of recovery, are 3.51, 3.02, 2.35ng/ml and 0.12, 0.25, 0.5ng/kg/min with 5, 10, 20ng/kg loading in plastic surgery patients. We recommand 0.25ng/kg infusion with 10ng/kg loading of alfentanil combined with 3.02ng/ml of target plasma concentration of propofol as the best combination dosage to shorten recovery time.
Alfentanil* ; Analgesia ; Anesthesia ; Anesthesia, Intravenous ; Humans ; Nitrous Oxide ; Plasma ; Propofol* ; Surgery, Plastic*

BACKGROUND: Sevoflurane anesthesia is associated with emergence agitation in children. In this study, we compared the emergence and recovery profiles of children who received sevoflurane with fentanyl or alfentanil for inguinal herniorrhaphy. METHODS: Forty-five children receiving sevoflurane anesthesia for inguinal herniorraphy were assigned to three groups. Saline 0.1 ml/kg (group S), alfentanil 10microgram//kg (group A) or fentanyl 1microgram//kg (group F) was administered intravenously at the beginning of fascia closure. Duration of operation and anesthesia and emergence time were evaluated at the operating room. Agitation score, a degree of pain, the time of stay in PACU (postanesthetic care unit) and postoperative side effects were evaluated by a blinded observer at the PACU. RESULTS: The emergence time was prolonged in the group F compared to the other groups. The time of stay in PACU was prolonged in the group F compared to the group S. Group A and F had lower agitation score and pain score in comparison with that of the group S at the 0, 5, 10, 15 min in the PACU. Agitation score was also significantly lower in the group F compared to the group A at 30 min. CONCLUSIONS: We suggest that intravenous administration of alfentanil 10microgram//kg or fentanyl 1microgram//kg at the closure of fascia could effectively reduce the agitation score. Alfentanil also does not delay from emergence and the time of stay in the PACU.
Administration, Intravenous ; Alfentanil* ; Anesthesia* ; Child* ; Dihydroergotamine* ; Fascia ; Fentanyl ; Herniorrhaphy ; Humans ; Operating Rooms