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

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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.


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.


  1. 1

    Kay B, Stephenson DK. Alfentanil (R39209): Initial clinical experience with a new narcotic analgesic. Anaesthesia 1980; 35; 1197–201.

  2. 2

    Kay B, Pleuvry B. Human volunteer studies of alfentanil (39209), a new short-acting narcotic analgesic. Anaesthesia 1980; 35:952–6.

  3. 3

    de Castro J, van de Water A, Wouters L, Xhonneux R, Reneman R, Kay B. A comparative study of eight narcotics in dogs. Acta Anaesthesiolog Belg 1979; 30:5–54.

  4. 4

    Nauta J, de Lange S, Koopman D, Spierdijk J, Van Kleef J, Stanley TH. Anesthetic induction with alfentanil: a new short acting narcotic analgesic. Anesth Analg 1982; 61:267–72.

  5. 5

    Bidwai AV, Cornelius LR, Stanley TH. Reversal of Innovar induced postanesthetic somnolence and disorientation with physostigmine. Anesthesiology 1976; 44:249–51.

  6. 6

    Fox GS, Wynands HE, Bhambhambi M. A clinical comparison of diazepam and thiopentone as induction agents to general anaesthesia. Can Anaesth Soc J 1968; 15:281–90.

  7. 7

    McClish A. Diazepam as an intravenous induction agent for general anesthesia. Can Anaesth Soc J 1960; 13:562–75.

  8. 8

    Guerra F. Thiopental forever after, Trends in Intravenous Anesthesia. Edited byAldrete JA, Stanley TH. Chicago, Year Book, 1980, pp 143–51.

  9. 9

    Dundee JW, The ideal anesthetic(s), Trends in Intravenous Anaesthesia. Edited byAldrete JA, Stanley TH. Chicago, Year Book, 1980, pp 127–142.

  10. 10

    Stoelting RK. Attenuation of blood pressure response to laryngoscopy and tracheal intubation with sodium nitroprusside. Anesth Analg 1979; 58:116–9.

  11. 11

    Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation. Influences of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977; 47:381–4.

  12. 12

    Bidwai, AV, Rogers CR, Stanley TH, Wong KC, Gibbs S. Effect of edrophonium on heart rate and blood pressure responses to tracheal intubation. Anesthesiology 1980; 53:S131.

  13. 13

    Conway CM, Ellis DB. The haemodynamic effects of short acting barbiturates. Br J Anaesth 1969; 41:534–42.

  14. 14

    Etsten B, Li T, Hemodynamic changes during thiopental anesthesia in humans: cardiac output, stroke volume, total peripheral resistance and intrathoracic blood volume. J Clin Invest 1955; 34:500–10.

  15. 15

    Eckstein JW, Hamilton WK, MacCammond JM. The effects of thiopental on peripheral venous tone. Anesthesiology 1961; 22:525–8.

  16. 16

    Aldrete JA, Stanley TH. Trends in Intravenous Anesthesia. Chicago, Year Book, 1980.

  17. 17

    Stanley TH. Pharmacology of Intravenous Non-Narcotic Anesthetics. In Anesthesia, Edited byMiller R. Churchill-Livingstone, Inc. New York, 1981, Chapter 10.

  18. 18

    Hill AB, Nahrwold ML, de Rosayro AM, Knight PR, Jones RM, Bolls RE. Prevention of rigidity during fentanyl-oxygen induction of anesthesia. Anesthesiology 1981 ; 55:452–4.

  19. 19

    de Lange S, Stanley TH, Boscoe MB. Comparison of sufentanil-O2 and fentanyl-O2 anesthesia for coronary artery surgery. Anesthesiology 1982; 56:112–8.

  20. 20

    de Castro J. Practical applications and limitation of analgesic anaesthesia. Acta Anaesthesiolog Belg 1976; 27:107–28.

  21. 21

    de Lange S, Stanley TH, Boscoe MJ, Alfentanit-oxygen anaesthesia for coronary artery surgery. Br J Anaesth 1981; 53:1291–6.

  22. 22

    Stanley TH, Webster LR. Anesthetic requirements and cardiovascular effects of fentanyl-oxygen and fentanyl-diazepam in man. Anesth Analg 1978; 57:411–6.

  23. 23

    Stanley TH, Bennett GM, Loeser EA, Kawamura R, Sentker CR. Cardiovascular effects of diazepam and dropiderol during morphine anesthesia. Anesthesiology 1976; 44:255–7.

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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