Effects of remifentanil and alfentanil on the cardiovascular responses to
induction of anaesthesia and tracheal intubation in the elderly.
Author(s): Habib AS, Parker JL, Maguire AM, Rowbotham DJ, Thompson JP.
Affiliation(s): University Department of Anaesthesia, Critical Care and Pain Management,
University Hospitals of Leicester, Leicester Royal Infirmary, UK.
Publication date & source: 2002, Br J Anaesth. , 88(3):430-3
BACKGROUND: We compared the effects of remifentanil and alfentanil on arterial
pressure and heart rate at induction of anaesthesia and tracheal intubation in 40
ASA I-III patients aged greater than 65 yr, in a randomized double-blind study.
METHODS: Patients received either remifentanil 0.5 microg kg(-1) over 30 s,
followed by an infusion of 0.1 microg kg min(-1) (group R) or alfentanil 10
microg kg(-1) over 30 s, followed by an infusion of saline (group A). Anaesthesia
was then induced with propofol, rocuronium, and 1% isoflurane with 66% nitrous
oxide in oxygen.
RESULTS: Systolic arterial pressure (SAP) and mean arterial pressure (MAP)
decreased after the induction of anaesthesia (P<0.05) and increased for 3 min
after intubation in both groups (P<0.05), but remained below baseline values
throughout. Heart rate remained stable after induction of anaesthesia but
increased significantly from baseline after intubation for 1 and 4 min in groups
R and A, respectively (P<0.05). There were no significant between-group
differences in SAP, MAP, and heart rate. Diastolic pressure was significantly
higher in group A than group R at 4 and 5 min after intubation (P<0.05).
Hypotension (SAP < 100 mm Hg) occurred in four patients in group R and three
patients in group A.
CONCLUSIONS: Remifentanil and alfentanil similarly attenuate the pressor response
to laryngoscopy and intubation, but the incidence of hypotension confirms that
both drugs should be used with caution in elderly patients.
|