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: 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 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: 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 various methods have been used to prevent or minimize the increase of blood pressure and heart rate to endotracheal intubation. Opioids are the most widely used drug for hemodynamic stability. The purpose of this study was to compare the effects of fentanyl with those of alfentanil on hemodynamic changes to induction of anesthesia and endotracheal intubation. METHODS: Forty five patients were divided into three groups. They received intravenous fentanyl 1.0 microgram/kg, alfentanil 5 microgram/kg or saline 10 ml (control group), respectively. Baseline mean arterial blood pressure and heart rate were measured before the induction of anesthesia. Tracheal intubation was done 3 min after the injection of muscle relaxant. Mean arterial blood pressure and heart rate were measured every minute for 3 min after the induction of anesthesia and tracheal intubation and the results were compared with baseline value. RESULTS: Mean arterial blood pressure decreased significantly compared with baseline value after the induction of anesthesia, but there were no significant differences among the three groups. Heart rate initially increased and then decreased. After tracheal intubation, mean blood pressure and heart rate increased significantly in all groups. The extent of this was significantly lower in the alfentanil group and slightly lower in the fentanyl group than in the control group. CONCLUSIONS: Alfentanil is more effective than fentanyl at inhibiting cardiovascular responses following intubation, but further studies are needed to define the optimal injection time and drug dosage.
Alfentanil* ; Analgesics, Opioid ; Anesthesia* ; Arterial Pressure ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal*

BACKGROUND: Desflurane provides satisfactory surgical anesthesia when used alone or in combination with N2O or fentanyl or both. The goals of this study were to determine the effect of alfentanil infusion in the presence of desflurane and nitrous oxide. METHODS: Sixty patients undergoing plastic surgery were anesthetized with desflurane, 50% nitrousoxide, and alfentanil (10mu g/kg loading dose followed by 0.25mu g/kg/min infusion [group 1], 0.25mu g/kg/min infusion [group 2], no infusion [group 3]). The minimum alveolar concentration of desflurane, induction and recovery time, and perioperative side effects according to charge of the alfentanil regimen were checked. RESULTS: Induction and recovery time were shorter in group 1 (20.2 min, 4.5 min) and group 2 (30.0 min, 4.2 min) than group 3 (48.1 min, 7.9 min) (P < 0.05). Minimum alveolar concentration of desflurane was lower in group 1 (3.6 vol%) and group 2 (3.7 vol%) than group 3 (6.7 vol%) (P < 0.05). Incidences of hypotension and bradycardia were significantly higher in group 1 than group 2 or 3 (P < 0.05). CONCLUSIONS: We recommend 0.25mu g/kg infusion without a loading dose of alfentanil combined with 3.7 vol% of desflurane and 50% N2O as the best combination dosage in plastic surgery to shorten the induction and recovery time without significant side effects.
Alfentanil* ; Anesthesia ; Bradycardia ; Fentanyl ; Humans ; Hypotension ; Incidence ; Nitrous Oxide ; Surgery, Plastic

The short duration and fast onset of action of alfentanil underpins its suitability for use in anesthetic techniques. In these case studies, we have assessed the efficacy, safety and feasibility of alfentanil as an analgesic adjuvant of propofol based general anesthesia. Propofol was titrated to Keep the bispectral index in the 40 50 range. Alfentanil was infused at the effect site concentration of 80 or 160 ng/ml using a computer assisted continuous infusion. Two patients in this pilot study showed stable hemodynamics, smooth emergence and satisfactory postoperative pain control with additional analgesics in PACU.
Alfentanil ; Analgesics ; Anesthesia* ; Anesthesia, General ; Hemodynamics ; Humans ; Pain, Postoperative ; Pilot Projects ; Propofol

BACKGROUND: The aim of this study was to determine the clinical effective dose of rocuronium for tracheal intubation using a lightwand after induction with propofol, alfentanil, and a low concentration of sevoflurane. METHODS: Twenty-eight adults scheduled to undergo elective surgery lasting less than one hour were enrolled in this study. All patients received alfentanil (10 microgram/kg) and propofol (1.5 mg/kg) for the induction of anesthesia. Tracheal intubation using a lightwand was attempted 3 minutes after administering rocuronium and mask ventilation with 2 vol% of sevoflurane. The initial rocuronium dose was 0.5 mg/kg. The rocuronium dose for consecutive patients, determined by Dixon's up-and-down method, was increased or decreased by 0.05 mg/kg according to the result of the previous patient. The mean arterial pressure and heart rate were recorded before induction, 1 min before intubation, 1 and 2 min after intubation. RESULTS: The 50% clinical effective dose (cED(50)) of rocuronium for tracheal intubation using a lightwand was 0.20 +/- 0.05 mg/kg according to Dixon's up and down method. Isotonic regression revealed the cED(50) and cED(95) (95% confidence intervals) to be 0.20 mg/kg (0.10-0.3 mg/kg) and 0.35 mg/kg (0.16-0.49 mg/kg), respectively. CONCLUSIONS: The cED(50) and cED(95) of rocuronium for tracheal intubation using the lightwand were 0.20 mg/kg and 0.35 mg/kg, respectively, after induction with alfentanil, propofol, and a low concentration of sevoflurane.
Adult ; Alfentanil ; Androstanols ; Anesthesia ; Arterial Pressure ; Heart Rate ; Humans ; Intubation ; Masks ; Methyl Ethers ; Propofol ; Ventilation