title: Triple anesthetic combination: propofol-midazolam-alfentanil.
abstract: The hypnotic effects of propofol, midazolam, alfentanil, and their binary and triple combinations, were studied in 130 unpremedicated patients in a randomized, double-blind fashion. The ability to open eyes on verbal command was used as an end-point. Dose-response curves for the three drugs given separately and in combination were determined with a probit procedure and the ED50 values were compared with an isobolographic analysis. The ratios of a single-drug fractional dose (ED50 = 1.0) to a combined fractional dose (in fractions of single-drug ED50 values) indicating the degree of superadditivity (synergism) were: 1.4 (P < 0.05) for propofol-alfentanil, 1.8 (P < 0.0005) for midazolam-propofol, 2.8 (P < 0.0001) for midazolam-alfentanil, and 2.6 (P < 0.0001) for propofol-midazolam-alfentanil. The results indicate that the propofol-midazolam-alfentanil interaction produces a profound hypnotic synergism which is not significantly different from that of the binary midazolam-alfentanil combination.
authors.affiliation: Department of Anesthesiology, University of Alabama at Birmingham 35294.
authors.forename: H R
authors.initials: HR
authors.lastname: Vinik
authors.forename: E L
authors.initials: EL
authors.lastname: Bradley
authors.forename: I
authors.initials: I
authors.lastname: Kissin
mesh_terms: D000328:Adult; D015760:Alfentanil; D000777:Anesthetics; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D015742:Propofol
chemical_list: D000777:Anesthetics; D015760:Alfentanil; D008874:Midazolam; D015742:Propofol