Alfentanil decreases the excitatory phenomena of sodium methohexital.
OBJECTIVE
To evaluate the effects of alfentanil or lidocaine on the excitatory phenomena (myoclonus, cough, hiccough) caused by methohexital anesthesia and on the hemodynamic changes induced by retrobulbar block.


METHODS
Prospective, randomized, placebo-controlled, double-blind study.


METHODS
University-affiliated, tertiary-care hospital.


METHODS
60 ASA physical status II and III patients who were admitted for elective cataract extractions and intraocular lens implantations.


METHODS
Patients were randomly assigned to one of three groups. After adequate preoxygenation in the holding area, Group 1 received alfentanil 5 micrograms/kg intravenously (i.v.), Group 2 received lidocaine 1 mg/kg i.v. and Group 3 received the placebo (saline) i.v. Immediately after the bolus injection of the study solution, sodium methohexital 1.5 mg/kg was injected i.v. over 30 seconds. As soon as the eyelid reflex was lost, the retrobulbar block was placed over 5 seconds.


RESULTS
Occurrences of excitatory phenomena were recorded by an independent observer who was blinded as to treatment allocation. Other side effects such as oculocardiac reflex, nausea, vomiting, itching, or chest wall rigidity were recorded. Vital signs were recorded at baseline and 1, 3, and 5 minutes after placement of the block. In the alfentanil group, the incidence of myoclonus or cough was significantly less than in the lidocaine or placebo groups. Alfentanil also decreased systolic and diastolic blood pressure significantly at 1, 3, and 5 minutes after retrobulbar block. Changes in heart rate were not significantly different from baseline.


CONCLUSIONS
A small dose of alfentanil (5 micrograms/kg i.v.) decreases myoclonus and cough induced by sodium methohexital anesthesia i.v., resulting in improved quality of induction of anesthesia. Alfentanil also attenuates the cardiovascular responses caused by placement of a retrobulbar block.
Khalil
S N
SN
Department of Anesthesiology, University of Texas Medical School at Houston 77030, USA.
Howard
G
G
Mankarious
R
R
Campos
C
C
Kellaway
J
J
Chuang
A Z
AZ
Ruiz
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015760:Alfentanil / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008012:Lidocaine / Q000494:pharmacology; D008297:Male; D008723:Methohexital / Q000009:adverse effects*; D008875:Middle Aged; D009207:Myoclonus / Q000139:chemically induced; D012024:Reflex, Oculocardiac / Q000187:drug effects
D018686:Anesthetics, Intravenous; D015760:Alfentanil; D008012:Lidocaine; D008723:Methohexital