Total intravenous anaesthesia with propofol, alfentanil, and. Local anaesthetics are used very widely in dental practice, for brief and superficial interventions, for obstetric procedures, and for specialized techniques of regional anaesthesia calling for. Pdf dose of alfentanil needed to obtain optimal intubation. In 12 patients, the systolic bp declined to 16 gkg. Alfentanil 5 mgml solution for injection is a potent opioid analgesic with a very rapid onset of action. Between the end of anaesthesia and awakening, the number of patients receiving bolus doses of propofol and the cumulative dose of propofol did not differ significantly between the groups table 2. It is an analogue of fentanyl with around 14 to 110 the potency of fentanyl and around of the duration of action, but. Feb 17, 2020 the dosage of alfenta alfentanil hydrochloride should be individualized and titrated to the desired effect in each patient according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure and anesthesia. When the dose response curve for the propofol alfentanil combination is compared to effects of alfentanil or propofol alone, it is evident that the propofol alfentanil combination affords greater analgesia and sedation, but at no greater cost in terms of elevating endtidal carbon dioxide figure 4, figure 5, figure 6. Administration of alfentanil at anesthetic induction dosages above mcgkg will consistently produce muscular rigidity with an immediate. Burtles edinburgh dental hospital, uk abstract children recovering from intravenous methohexitone anaesthesia given for simple dental extractions frequently cry, or are restless and confused, during emergence from anaesthesia. Also, in this study, nausea and vomiting in the remifentanil group was significantly higher than the alfentanil group.
Alfentanil 5 mgml solution for injection summary of. In the clinic, alfentanil has been combined with propofol to achieve more effective intravenous anaesthesia. Reduce usual adult dose by up to 40% to account for reduced clearance and increased sensitivity. Oct 28, 2019 alfenta alfentanil is a sterile, nonpyrogenic, preservative free aqueous solution containing alfenta alfentanil hydrochloride equivalent to 500. Alfentanil r39209, trade name alfenta, rapifen in australia is a potent but shortacting synthetic opioid analgesic drug, used for anaesthesia in surgery. The clinical effective dose of alfentanil for suppressing cough during emergence from desflurane anesthesia article pdf available in korean journal of anesthesiology 614. With blood propofol concentrations increasing from 2 to 10 micro gramml, the ec 50 of alfentanil decreased from 170 to 25 ngml for laryngoscopy, from 280 to 23 ngml for intubation, from 259 to 9 ngml for the opening of the peritoneum, and from 209 to 16 ngml for the intraabdominal surgical stimuli. Oct 01, 2000 the total dose, auc, and t 50 of propofol were similar in all three groups table 4. Alfentanil and morphine mixtures anaesthesia, 2001, 56, pages 739744. Alfentanil with methohexitone in paediatric dental anaesthesia. Percutaneous nephrolithotripsy pcnl is used for the fragmentation and removal of stones from the renal pelvis and renal calyceal systems. Methods the protocol was approved by the leiden univer. Alfentanil given immediately before the induction of. A total of 60 asa i patients were randomly allocated to five different alfentanil dose groups 0, 15, 30, 45, or 60 g kg.
Alfentanil is synthetic opioid phenylpiperidine seriestetrazole derivative of fentanyl introduced in 1980. The combined spinalepidural cse technique, a comparatively new anesthetic choice, includes an initial subarachnoid injection followed by epidural catheter placement and subsequent administration of epidural medications. It is approved by the fda as an anesthetic agent in adults and children. Drugs used for conduction anaesthesia also termed local or regional anaesthesia act by causing a reversible block to conduction along nerve fibres.
We compared the effects of propofolalfentanil or propofolremifentanil anaesthesia on haemodynamics, recovery characteristics and postoperative analgesic requirements during percutaneous nephrolithotripsy. Comparison of propofolalfentanil and propofolremifentanil anaesthesia in percutaneous nephrolithotripsy volume 22 issue 9 m. Anesthesia was maintained with 50% nitrous oxide, 0. Reduce usual adult dose by up to 40% to account for reduced clearance and increased sensitivitysubsequent doses should be based on the effect of the initial dose. Significant dose effects were observed for ep amphtude during but not beyond the distributional t 12 of the drug, but significant effects on the pr extended beyond this. Alternatively, it could be considered that the effects of alfentanil would have. Alfentanil for intubation under halothane anaesthesia in. Summary the effect of the addition of a single dose of 7. Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia beverly k. Recurrent respiratory depression after total intravenous.
The incidence and severity of muscle rigidity is usually doserelated. Pdf the primary aim of the present study was to determine the dose of alfentanil. Recurrent respiratory depression after total intravenous anaesthesia with propofol and alfentanil. Dose requirements for propofol and the effect of premedication with clonidinef m. View the article pdf and any associated supplements and figures for a period of 48 hours. The alfentanil dose needed to obtain optimal intubation conditions in 95% of the patients was 36. The dosage of alfentanil should be individualised according to age, body weight, physical status, underlying pathological condition, use of other medicines, type of anaesthesia and type and duration of the surgical procedure. We chose not to use an equipotent dose of alfentanil because of the potential for prolonged recovery. The infusion profile of alfentanil was found using the computer program of maitre and colleagues 7. The comparison of alfentanil and remifentanil infusion. Remifentanil compared with alfentanil for ambulatory. The use of alfentanil in a syringe driver in palliative medicine warning. The pharmacodynamic interaction of propofol and alfentanil.
Highlights of prescribing information these highlights do. Use of alfentanil in renal failure in palliative care in. The solution, which contains sodium chloride for isotonicity, has a ph range of 46. The propofolalfentanil admixture pa provides the double effects of anaesthesia and analgesia with the advantages of fast onset and convenience of. The pharmacokinetic properties of different agents determine their analgesic and side effect profiles. The short t 50 of propofol did not correlate with recovery. Prysroberts oxide 35, or with opioids such as fentanyl or alfentanil to provide total i.
The use of alfentanil in a syringe driver in palliative medicine. Find patient medical information for alfentanil injection on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. In order to determine these responses under conditions of stable blood concentrations of propofol, we utilized a manual infusion scheme. The dose of alfentanil hcl injection should be reduced in elderly. Propofol and alfentanil infusion propofol and alfentanil infusion kay, b. The initial dose of alfentanil hcl injection should be appropriately reduced in elderly.
In a singleblind patient blinded, randomized, controlled trial, investigators at an urban county medical center compared alfentanil with propofol for procedural sedation. Alfentanil may be used as the analgesic component of anaesthesia for long lasting surgical procedures, especially when rapid extubation is indicated. Hepatic impairment a dose reduction of 3050% may be necessary. This dose of remifentanil provides more effective sup. Supplemental bolus dose of 1 mcgkg may be administered every 25 minutes. The purpose of this study was to test the hypothesis that using a 1. Three different dosage schemes of propofol infusions combined with a fixedrate alfentanil infusion were investigated in total intravenous anaesthesia. Review of remifentanil and its clinical use dr ted wong singapore general hospital. The incidence and severity of muscle rigidity is usually dose related. Bispectral index bis monitoring offers an alternative means of titration i. Generalanesthesia interact with whole body, function of central nervous system is depressed. Recovery times after remifentanilpropofol versus alfentanilpropofol anaesthesia. Alfentanil dosage when inserting the classic laryngeal mask. Alfentanil fda prescribing information, side effects and uses.
Contraindications alfentanil is contraindicated in those with a known intolerance or sensitivity to alfentanil, or to other opioid analgesics. Sufenta sufentanil dosing, indications, interactions. Comparison of propofolalfentanil and propofolremifentanil. The pharmacodynamic interaction of propofol and alfentanil during lower abdominal surgery in women. In a singleblind patient blinded, randomized, controlled trial, investigators at an urban county medical center compared alfentanil with propofol for procedural sedation when a moderate depth of sedation was targeted. Alfenta alfentanil is a sterile, nonpyrogenic, preservative free aqueous solution containing alfenta alfentanil hydrochloride equivalent to 500. Although obese patients do require a larger dose than their lbw would suggest, it is far less than their. Patientcontrolled sedation and analgesia with propofol and. In a syringe driver, alfentanil is compatible with other commonly prescribed symptom control medications of midazolam, levomepromazine and hyoscine butylbromide. The comparison of alfentanil and remifentanil infusion during.
Use of a combination of propofol and fentanyl, alfentanil. Less potent15th to 110th and has rd the duration of action of fentanyl. Alfentanil is a sensitive cyp3a4 substrate, and coadministration with cyp3a inhibitors like crizotinib can increase alfentanil exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of alfentanil. A bolus was given when the patient pressed the delivery button. Alfentanil administered in initial dosages up to 20 mcgkg may cause skeletal muscle rigidity, particularly of the truncal muscles. For the breakthroughprn dose divide the 24 hour dose by 6.
May 15, 2012 alfentanil is synthetic opioid phenylpiperidine seriestetrazole derivative of fentanyl introduced in 1980. A total of 53 asa grade 1 or 2 patients who underwent daycase dental surgery were allocated randomly to receive either alfentanil or saline. Wang mb chb, frca department of anaesthesiology, faculty of medicine, university of malaya, 50603 kuala lumpur, malaysia summa y, intubating conditions under halothane anaesthesia aided with. British journal of anaesthesia, volume 98, issue 5, may 2007, pages 604610. Oct 02, 2018 alfentanil administered in initial dosages up to 20 mcgkg may cause skeletal muscle rigidity, particularly of the truncal muscles. Doses of alfentanil hcl injection vary depending on circumstances see dosing chart, 2. The dosage of alfenta alfentanil hydrochloride should be individualized and titrated to the desired effect in each patient according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure and anesthesia. Alfentanil is a shortacting opioid analgesic commonly compared to fentanyl. The clinical effective dose of alfentanil for suppressing. Patientcontrolled sedation and analgesia with propofol.
Dose of alfentanil needed to obtain optimal intubation conditions. The total alfentanil dose was significantly greater in the patients of group a compared with those of group b and c. Dose of alfentanil needed to obtain optimal intubation. These results indicate that anaesthesia with an alfentanil infusion provides satisfactory. Since first commented upon by lamarche in 1984, several cases of recurrent respiratory arrest after alfentanil infusions have been reported. Use of alfentanil in renal failure in palliative care in lincolnshire. Therefore, the alfentanil dose proposed in this study may not be sufficient for situations requiring absolute smooth emergence. General anaesthesia use of remifentanil during general anaesthesia usually requires a cet of 310 ng.
The primary aim of the present study was to determine the dose of alfentanil that must be added to a. Mean volume of distribution, total body clearance, and distribution t 12 did not differ significantly across the doses of alfentanil. Remifentanil compared with alfentanil for ambulatory surgery. Alfentanil fda prescribing information, side effects and. The effects of a propofolalfentanil admixture on total intravenous. Dose of alfentanil needed to obtain optimal intubation conditions during rapidsequence induction of anaesthesia with. Many agents that have fallen from favour in more developed countries are still widely. The relationship between the alfentanil dose and the probability of optimal. Department of anaesthesia hope hospital salford m6 8hd uk anaesthesiaupdate in summary opioid drugs are widely used as moderate to strong analgesic agents. Forty asa iiii patients recovering from major abdominal or orthopedic operations were investigated in an open clinical study to evaluate analgesic efficacy and threshold plasma concentrations of alfentanil during the early postoperative period using patientcontrolled analgesia pca by means of the ondemand analgesia computer. In conclusion, the 95% effective dose ed 95 of alfentanil for suppressing cough during emergence from desflurane anesthesia is 14 gkg using dixons upanddown method and isotonic regression. Other routes of administration have not been evaluated. A mixture of alfentanil and morphine for rapid postoperative. In recent years, regional anesthesia techniques for surgery, obstetrics, and postoperative pain management have been used with increasing frequency.
Recurrent respiratory depression after total intravenous anaesthesia. The effects of a propofolalfentanil admixture on total. Total intravenous anaesthesia with propofol, alfentanil. Significant dose effects were observed for ep amphtude during but not beyond the distributional t 12 of the drug, but significant effects on the pr extended beyond this time point. Dose effects of alfentanil in human analgesia hill 1986. In all these cases the alfentanil infusions have been used to supplement conventional anaesthetic techniques with nitrous oxide andor inhalational agents and in most cases rather high total alfentanil doses have been administered. An infusion of six times these doses per hour was then started. In all these cases the alfentanil infusions have been us. Induction of anaesthesia was achieved in both groups with bolus doses of alfentanil 250 ug and propofol 1 mg kg1 with additional propofol 2030 mg, if necessary. Consider increasing concomitant anesthetics with infusion rate 1 mcgkgminute. This suggests that the alfentanil serves to fill the early gap in the morphine curve rather than contribute greatly to later analgesia produced by morphine.
Alfentanil given immediately before the induction of anesthe. Effects of combining propofol and alfentanil on ventilation. Alfentanil hydrochloride alfentanil hydrochloride dose. In this doubleblinded study of elective cesarean deliveries, 40 patients were allocated randomly to receive either alfentanil 10. Ranges can be used in the same way as other opioids. May 25, 2017 alfentanil is an ultrashortacting opioid that induces analgesia for 7 to 9 minutes. Dose conversion alfentanil is approximately 15 times as potent as subcutaneous sc morphine. Comparison of alfentanil, fentanyl and sufentanil for total. A blinded dose of alfentanil followed by thiopentone 4 mg kg. Optimum analgesia and stable autonomic condition are. Anesthesia was then induced by first injecting the study drug over 10 s, followed immediately by injecting propofol 2.
Alfentanil is a controlled drug that comes in several strengths. Remifentanil jordan university of science and technology. Postoperative patientcontrolled analgesia with alfentanil. In conclusion, remifentanil can be used for maintenance of anesthesia in a 1.
The dose of alfentanil hcl injection should be reduced in elderly or debilitated patients see warnings and precautions. Alfentanil is an ultrashortacting opioid that induces analgesia for 7 to 9 minutes. Remifentanil is approximately five to ten times more potent than alfentanil when administered by continuous infusion 1 data on file, glaxo wellcome inc. Atotw 342 th remifentanil use in anaesthesia and critical care 29 nov 2016 page 3 of 9 the pharmacokinetics of remifentanil are more closely associated with lean body weight lbw rather than actual body weight abw1. Pdf alfentanil was administered, together with midazolam, as part of a total i. The use of alfentanil in a syringe driver in palliative. It is indicated for analgesia and suppression of respiratory activity in mechanically ventilated patients on intensive care and to provide analgesic cover for painful manoeuvres. It may also be associated with the infusion dose of this drug and may require remifentanil dose adjustment in subsequent studies. In 30 premedicated patients, divided at random into three groups, anaesthesia was induced with propofol 2 mg kg. Oct 01, 2019 in one clinical trial, the dose of alfentanil required to produce anesthesia, as determined by appearance of delta waves in eeg, was 40% lower in geriatric patients than that needed in healthy young patients. Dose effects of alfentanil in human analgesia hill. The study was blinded so that neither the anaesthetist nor the assessor was. Effects of combining propofol and alfentanil on ventilation, analgesia, sedation, and emesis in human volunteers.
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