Comparison of remifentanil and alfentanil during anaesthesia for patients undergoing direct laryngoscopy without intubation.
BACKGROUND
Remifentanil and alfentanil are opioids often used during direct laryngoscopy (DL). This prospective, randomized study compared these agents with respect to haemodynamic and Bispectral Index (BIS) responses, glottic visualization, and rapidity of recovery (spontaneous ventilation, eye opening) in DL without intubation.


METHODS
A total of 60 patients undergoing DL were randomized into two groups: remifentanil (R) and alfentanil (A). Anaesthesia was induced with propofol 2.5 mg kg(-1) and the opioid was administered 1 min later (R=2 microg kg(-1) or A=30 microg kg(-1) over 30 s). DL was commenced 1 min after (corresponding to 3 min after the beginning of induction). Glottic visualization, opioid and/or propofol re-injection, spontaneous ventilation recovery, and eye opening were recorded.


RESULTS
During DL, mean arterial pressure (MAP) increased by 6% in the R group vs 20% in the A group (P<0.05) when compared with post-induction values without affecting heart rate or BIS. No significant difference was observed between groups with respect to glottic exposure, opioid and/or propofol re-injection, and spontaneous ventilation recovery (mean (SEM) 3.8 (0.6) min, R group vs 3.2 (0.7) min, A group, NS) or eye opening (7.1 (1.1) min, R group vs 7.4 (0.9) min, A group, NS). Thirty minutes after postanaesthesia care unit (PACU) admission, MAP returned to its pre-induction value in the R group (104 (3) vs 109 (3) at baseline, NS), whereas in the A group MAP remained significantly lower at this time point (96 (4) vs 106 (3) at baseline, P<0.05).


CONCLUSIONS
This study showed that only remifentanil prevented MAP increase without adverse effects such as bradycardia during DL, and prevented MAP decrease 30 min after PACU admission.
Wiel
E
E
Department of Anaesthesia and Intensive Care Medicine, University Hospital of Lille, rue Michel Polonovski, F-59037 Lille cedex, France. e-wiel@chru-lille.fr
Davette
M
M
Carpentier
L
L
Fayoux
P
P
Erb
C
C
Chevalier
D
D
Vallet
B
B
D000328:Adult; D015760:Alfentanil; D000701:Analgesics, Opioid; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D010880:Piperidines; D011446:Prospective Studies; D000077208:Remifentanil
D000701:Analgesics, Opioid; D010880:Piperidines; D015760:Alfentanil; D000077208:Remifentanil