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 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: 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: 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: High doses of intrathecal bupivacaine may produce a high level of sensory and motor block, and arterial hypotension and, Intrathecal opioids added to low-dose local anesthetics produced a synergistic effect Thus it may be possible to augment spinal anesthesia without delaying recovery. The aim of this study was to investigate the efficacy and adverse effects of adding alfentanil to intrathecal small-dose bupivacaine for short-duration surgery. METHODS: In this randomized double-blinded, prospective study, 60 patients scheduled for short-duration surgery were randomly assigned to Group B10 (0.5% bupivacaine 10 mg), Group B5AE (0.5% bupivacaine 5 mg + alfentanil 0.25 mg + 0.1% epinephrine 0.2 ml + normal saline 0.3 ml), or Group B5A (0.5% bupivacaine 5 mg + alfentanil 0.25 mg + normal saline 0.5 ml). The final volume of intrathecal injectate was adjusted to 2.0 ml with normal saline. Neural block was assessed by pinprick and a modified Bromage scale. RESULTS: No significant difference was found between three groups at the median peak sensory level, but administered fluid, and the duration of sensory and motor blockade in Group B5A was significantly shorter than in Group B10. CONCLUSIONS: We conclude that alfentanil 0.25 mg with 0.5% bupivacaine 5 mg produced a shorter in neural blockade, than the other groups and that it did not cause hemodynamic instability and produced effective spinal anesthesia for short-duration surgery.
Alfentanil* ; Analgesics, Opioid ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine* ; Epinephrine ; Hemodynamics ; Humans ; Hypotension ; Prospective Studies

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: Patient-controlled sedation (PCS) with propofol is a safe and effective method of attenuating discomfort during fiberoptic bronchoscopy. The purpose was to evaluate the usefulness of midazolam in addition to PCS for fiberoptic bronchoscopy. METHODS: We randomly assigned 155 patients undergoing diagnostic bronchoscopy to two groups. Group M (n = 79) received 0.03 mg/kg of midazolam for premedication while group P (n = 76) received a loading dose (0.05 ml/kg) of PCS solution composed of 200 mg (20 ml) of propofol and 1 mg (2 ml) of alfentanil. Both groups received the PCS solution 0.2 ml/kg/hr with a bolus of 1 ml and a lockout time of 1 min. Vital signs, pulmonologist satisfaction, patient satisfaction and amnesia were evaluated. RESULTS: After the insertion of the bronchoscope, there was a slight decrease of SpO2 and an increase of blood pressure and heart rate in both groups with no significant differences between the two groups. The group P required more bolus injections (1.6 +/- 1.7 in the group M vs 2.5 +/- 2.2 in group P; P < 0.05). There was no difference in the satisfaction of pulmonologists, but the satisfaction of patients was higher in the group M (P < 0.05). More patients in the group P (93%) remembered the procedure than in the group M (70%) (P < 0.05). CONCLUSIONS: PCS is an effective method for sedating patients undergoing fiberoptic bronchoscopy and midazolam provides more patient satisfaction and amnesia.
Alfentanil ; Amnesia ; Blood Pressure ; Bronchoscopes ; Bronchoscopy ; Heart Rate ; Humans ; Midazolam ; Patient Satisfaction ; Premedication ; Propofol ; Vital Signs

BACKGROUND: The combination of propofol and alfentanil for nonrelaxant intubation produces hypotension and bradycardia. N2O, a commonly used inhaled anesthetic, has been known to augment the anesthetic depth in propofol anesthesia. Conversely, N2O was reported to increase the incidences of opioid-induced cough and rigidity. This study was designed to evaluate the effect of additional N2O on propofol requirement and intubating conditions. METHODS: Eighty healthy premedicated female patients were divided into N2O group (n = 40) and non-N2O group (n = 40). In each group, they were randomly assigned to four subgroups according to the propofol dose (1.0-2.5 mg/kg). With or without N2O (FiN2O = 0.5), propofol and 30mug/kg of alfentanil were administered during the induction of anesthesia. Expired concentrations of N2O were measured. Intubation was the attempted and intubating condition was scored (0-6). Incidences of cough and rigidity were also recorded. Dose of propofol for smooth intubation (score > 5) was analyzed and compared between groups. The conditions for smooth intubation were analyzed with variables (expired concentration of N2O, dose of propofol, age, incidences of hypotension, bradycardia, cough and rigidity) by logistic regression. RESULTS: The expired concentration of N2O was 33.0-3.8%. Propofol ED50 for smooth intubation was 1.67 mg/kg (1.26-2.19) in the N2O group and 2.27 mg/kg (1.78-3.47) in the non-N2O group. A smooth intubating condition was correlated well with increased concentrations of N2O and doses of propofol and inversely correlated with incidences of cough and rigidity. However, we failed to prove a significant difference in incidences of hypotension, bradycardia, cough and rigidity between the two groups. CONCLUSIONS: We cannot reduce the propofol requirement for smooth intubation without relaxant by using N2O. The success rate of intubation was increased by additional N2O.
Alfentanil ; Anesthesia ; Bradycardia ; Cough ; Female ; Humans ; Hypotension ; Incidence ; Intubation* ; Logistic Models ; Nitrous Oxide ; Propofol