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  • Title: A clinical trial of alfentanil as an adjuvant for short anaesthetic procedures.
    Author: Hull CJ, Jacobson L.
    Journal: Br J Anaesth; 1983; 55 Suppl 2():173S-178S. PubMed ID: 6418190.
    Abstract:
    Alfentanil 700 micrograms and fentanyl 100 micrograms were compared as anaesthetic adjuvants in 90 patients undergoing short duration gynaecological procedures. The results show that, at the chosen dose ratio, alfentanil causes a higher frequency of post-induction apnoea, but thereafter the respiratory effects of the two drugs were comparable. No differences in incremental requirements or evoked movements were found. Among patients who had been given ergometrine, the alfentanil group suffered a greater frequency of nausea and vomiting in the period immediately after operation. It is concluded that in single i.v. doses, alfentanil 700 micrograms is more potent than fentanyl 100 micrograms. Moreover, the results suggest that, unlike fentanyl, this very short acting agent would be used to greater effect if given in divided doses during surgery. This study used a double-blind, randomized procedure to compare alfentanil with fentanyl as an adjuvant to anesthesia for short gynecological procedures. 90 healthy female patients age 16-65 years and weighing between 40-80 kg who were undergoing dilatation and curettage (D and C), evacuation of the products of conception (ERPC), or suction termination of pregnancy (TOP) were randomly assigned to group A (alfentanil) or group F (fentanyl). All patients were premedicated with lorazepam 1 mg. Each patient received either fentanyl 100 mcg or alfentanil 700 mcg, followed immediately by 1% methohexitone (plus 0.1% lignocaine) given in 10 mg increments every 15 seconds until the eyelash reflex was obtunded. The patients then breathed 66% nitrous oxide in oxygen. Patients undergoing TOP or ERPC were given ergometrine .25 mg intravenously at the start of cervical dilatation. Throughout the procedure, an online HP-8S computer gathered data on a peripheral interrupt basis. Data from the D and C patients was treated separately from that for TOP and ERPC patients; marked differences were found in incremental requirements for methohexitone, the frequency of apnea, the observed respiratory rates, and the mean arterial pressure. In both D and C and TOP groups, the mean induction doses of methohexitone in group F patients exceeded those in group A, but the differences were not significant, indicating that the analgesic effects did not differ greatly in intensity. The frequency and duration of apnea following induction were greater in patients given alfentanil. Despite the high frequency of apnea in group A patients, the frequency of physical responses to surgery and the need for incremental methohexitone did not differ. The results suggest that alfentanil does not improve the quality of anesthesia and does not discernibly reduce recovery time or the frequency of immediate postoperative nausea and vomiting.
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