title: Alfentanil controls the haemodynamic response during rapid-sequence induction of anaesthesia.
abstract: Laryngoscopy and tracheal intubation often cause hypertension and tachycardia, which may be exaggerated during rapid-sequence induction of anaesthesia. A placebo-controlled, double-blind study was conducted in 60 patients to determine dose-response and effects on myocardial performance of alfentanil when used to attenuate this cardiovascular response. Patients were divided into four groups to receive a pre-induction bolus from a coded syringe, which contained either normal saline (PLAC), alfentanil 30 micrograms.kg-1 (ALF 30), alfentanil 45 micrograms.kg-1 (ALF 45) or alfentanil 60 micrograms.kg-1 (ALF 60). Anaesthesia was induced in rapid sequence with thiopentone 4.0 mg.kg-1 and succinylcholine 1.5 mg.kg-1, and the trachea was intubated 60 sec later. Increases in heart rate (21 +/- 10 bpm), mean arterial pressure (28 +/- 13 mmHg), and systemic vascular resistance index (1420 +/- 780 dynes.sec-1.cm-5) were observed in response to intubation with PLAC but in none of the 3 ALF groups (P less than 0.05). However, heart rate and mean arterial pressure decreased significantly in both the ALF 45 and ALF 60 groups (P less than 0.05), whereas ALF 30 resulted in no change in these variables over time. Cardiac index, stroke volume index, and ejection fraction tended to decrease in all four groups, but none of these variables was different at corresponding time when comparing the ALF groups with PLAC.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Anaesthesia, Ottawa General Hospital, Ontario.
authors.forename: R J
authors.initials: RJ
authors.lastname: Martineau
authors.forename: C P
authors.initials: CP
authors.lastname: Tousignant
authors.forename: D R
authors.initials: DR
authors.lastname: Miller
authors.forename: K A
authors.initials: KA
authors.lastname: Hull
mesh_terms: D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage / Q000494:pharmacology*; D000704:Analysis of Variance; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002307:Cardiography, Impedance; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000502:physiology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D010919:Placebos; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D010919:Placebos; D015760:Alfentanil