Choice of opioid supplementation for day-case rigid bronchoscopy:a randomized placebo-controlled comparison of a bolus of remifentanil and alfentanil.
OBJECTIVE
To compare the efficacy of different bolus doses of remifentanil, alfentanil, and saline at controlling the hemodynamic responses to day-case rigid bronchoscopy under general anesthesia.


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


METHODS
Tertiary referral cardiothoracic hospital, single center.


METHODS
Eighty consenting adults scheduled for elective day-case rigid bronchoscopy under general anesthesia.


METHODS
Patients were randomized to receive a bolus of 10 micro g/kg of alfentanil, 1 micro g/kg of remifentanil, 2 micro g/kg of remifentanil or saline. After this, anesthesia was induced and maintained with a target-controlled propofol infusion (TCI) and succinylcholine was used for muscle relaxation. Heart rate and noninvasive arterial pressure were measured at 1-minute intervals throughout.


RESULTS
Patients' characteristics were similar in all 4 groups. There were no differences in time to return of spontaneous ventilation, wake-up times, or use of rescue vasopressors, and no patients complained of postoperative nausea. Remifentanil provided greater hemodynamic stability than alfentanil and a bolus of remifentanil of 2 micro g/kg significantly attenuated the rise in heart rate and was the most effective in preventing a rise in blood pressure.


CONCLUSIONS
A bolus of 2 micro g/kg of remifentanil successfully attenuated the hemodynamic response to rigid bronchoscopy without delaying recovery.
Agnew
Neil M
NM
Department of Anaesthesia, The Cardithoracic Centre Liverpool NHS Trust, Liverpool, England. neil.agnew@breathmail.net
Tan
Ngukhoon H
NH
Scawn
Nigel D A
ND
Pennefather
Stephen H
SH
Russell
Glenn N
GN
D000368:Aged; D015760:Alfentanil / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019540:Area Under Curve; D001794:Blood Pressure / Q000187:drug effects; D001999:Bronchoscopy; D003971:Diastole / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000628:therapy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy; D010880:Piperidines / Q000627:therapeutic use; D011446:Prospective Studies; D000077208:Remifentanil; D013599:Systole / Q000187:drug effects; D013610:Tachycardia / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D000701:Analgesics, Opioid; D010880:Piperidines; D014662:Vasoconstrictor Agents; D015760:Alfentanil; D000077208:Remifentanil