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Anaesthetic induction with alfentanil: Comparison with thiopental, midazolam, and etomidate

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Abstract

The speed, side effects and cardiovascular changes associated with anaesthetic induction and endotracheal intubation following alfentanil (20 μg/kg/min, IV), thiopental (84 μg/kgfmin, IV), etomidate (5 μg/kg/mint IV) and midazolam (20 μg/kg/min, IV)prior to halothane-nitrous oxide general anaesthesia were evaluated and compared in 80 patients undergoing elective general surgical operations. Anaesthetic induction was fastest with etomidate and thiopental (approximately one minute) and slowest with midazolam (about two minutes). Systolic arterial blood pressure (SBP) was decreased at the moment of unconsciousness with thiopental but unchanged with the other compounds. Heart rate (HR) was increased at unconsciousness with midazolam and thiopental but unchanged with etomidate and alfentanil. After intubation HR was increased in all groups except those induced with alfentanil. Arrhythmias were infrequent (5 per cent or less in all groups). Rigidity during induction only occurred with alfentanil (55 per cent) and pain on injection only with etomidate (35 per cent) and alfentanil (5 per cent). Postoperative vomiting was infrequent in all groups (15 per cent) except etomidate (55 per cent). No patient remembered any aspect of laryngoscopy or the operation and all rapidly regained consciousness at the end of operation. The results of this study demonstrate that with the exception of rigidity (which is easily overcome with succinylcholine) and a slightly slower onset of action, alfentanil compares favourably as an induction agent with thiopental and is better than midazolam and etomidate. Alfentanil is superior to all three other induction agents with respect to cardiovascular stability during induction and intubation.

Résumé

On a mesuré la vitesse d’induction anesthétique, les effets secondaires et les changements cardio-vasculaires associés à l’induction et l’intubation trachéales après l’administration de l’alfentanil (20 μg/kg/min, IV), le thiopental (84 μg/kg/min, IV), l’étomidate (5 μg/ kg/min, IV) et le midazolam (20 μg/kg/min, IV) antérieurement à l’administration d’halotane de protoxyde d’azote pour l’anesthésie générale. On a évalué et comparé cette induction chez 80 patients réglés pour interventions chirurgicales générales. L’induction anesthétique avec l’étomidate et le thiopental (approximativement une minute) se faisait plus rapidement, mais plus lentement avec le midazolam (environ deux minutes). La tension artérielle systolique (TAS) baissa dès l’instant où le patient s’endormit avec la dose de thiopental mais ne changea pas avec les autres composés. La fréquence cardiaque (FC) augmenta chez les patients endormis recevant le midazolam mais resta inchangée avec l’étomidate et l’alfentanil. Après l’intubation, la fréquence artérielle (FA) s’éleva chez tous les groupes mais non pas chez ceux recevant l’alfentanil. L’arythmie était moins fréquente (5 pour cent ou moins chez tous les groupes). On observa une rigidité seulement avec l’induction de l’alfentanil (55 pour cent) et une sensation de douleur avec l’injection d’étomidate (35 pour cent), avec l’alfentanil (5 pour cent). Les vomissements post-opératoires sont infréquents chez tous les groupes (15 pour cent) sauf chez ceux recevant l’étomidate (55 pour cent). Aucun patient ne se souvient de l’intervention chirurgicale ni de h laryngoscopie et la période de réveil s’effectua rapidement vers la fin de l’opération chirurgicale. Les résultats de cette recherche démontrent donc que à part la rigidité (qui est facilement corrigée avec le succinylcholine) et un léger début d’inhibition, l’alfentanil est un agent favorable d’induction avec le thiopental et est plus efficace que le midazolam et l’étomidate. L’alfentanil est un agent supérieur d’induction comparé aux trois autres agents par rapport à sa stabilité cardiovasculaire observée pendant l’induction et l’intubation.

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Author information

Correspondence to Jelle Nauta or Theodore H. Stanley or Simon de Lange or David Koopman or Johan Spierdijk or Jack van Kleef.

Additional information

Supported in part by Stanley Research Foundation.

An erratum to this article is available at http://dx.doi.org/10.1007/BF03007854.

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Nauta, J., Stanley, T.H., de Lange, S. et al. Anaesthetic induction with alfentanil: Comparison with thiopental, midazolam, and etomidate. Can Anaesth Soc J 30, 53–60 (1983). https://doi.org/10.1007/BF03007717

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Key Words

  • anaesthetics
  • intravenous: alfentanil
  • thiopental
  • midazolam
  • etomidate
  • induction: anaesthesia