Abstract
We have investigated the use of alfentanil by infusion to sedate 14 patients during controlled ventilation on the intensive therapy unit (ITU). An initial rate of 24 μg·kg-1·h-1 was chosen and altered there-after according to patient response. Incremental doses of midazolam (2.5–5.0 mg) were given intravenously (i.v.) if indicated. In 4 patients, the use of a muscle relaxant was necessary to allow adequate controlled ventilation of the patient. The mean duration of infusion was 27.9 h (range 10–141 h), and the mean total dose of alfentanil was 69.3 mg (12.5–240 mg). Spontaneous ventilation was rapidly achieved in 11 patients after stopping the infusion. The mean arterial carbon dioxide tension (PaCO2) was 5.38 kPa, 15–30 min after stopping the infusion. The clinical condition of 2 patients necessitated a change in sedation technique and one patient died during the alfentanil infusion. Alfentanil by infusion caused no major cardiovascular effects and did not influence the plasma cortisol response to trauma. There was no major alteration in blood biochemistry or haematology during the infusions of alfentanil. The plasma concentrations of alfentanil during infusion showed a wide variability. These probably relate to both changes in the volume of distribution of the drug and in hepatic clearance.
Article PDF
Similar content being viewed by others
References
Yate PM, Thomas D, Sebel PS (1984) Altentanil infusion for sedation and analgesia in intensive care. Lancet 2:396
Merriman HM (1981) The techniques used to sedate ventilated patients. A survey of methods used in 34 intensive care units in Great Britain. Intensive Care Med 7:217
Byatt CM, Lewis LD, Dawling S, Cochrane GM (1984) Accumulation of midazolam after repeated dosage in patients receiving mechanical ventilation in an intensive care unit. Br Med J 289:799
Wagner RL, White PF, Kan PB, Rosenthal MH, Feldman D (1984) Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med 310:1415
Editorial (1984) Sedation in the intensive care unit. Lancet 1:748
Gast PH, Fisher A, Sear JW (1984) Intensive care sedation now. Lancet 2:863
Moore A, Sear J, Baldwin D, Allen M, Hunniset A, Bullingham MR, McQuay H (1984) Morphine kinetics during and after renal transplantation. Clin Pharmacol Ther 35:641
McQuay H, Moore A (1984) Be aware of renal function when prescribing morphine. Lancet 2:284
Kay B, Pleuvry B (1980) Human volunteer studies of alfentanil (R39209), a new short-acting analgesic. Anaesthesia 35:352
Kay B, Stephenson DK (1980) Alfentanil (R39209): initial experience with a new narcotic analgesic. Anaesthesia 35:1197
Bower S, Hull C (1982) Comparative pharmacokinetics of fentanyl and alfentanil. Br J Anaesth 54:87
Andrews CJH, Sinclair ME, Prys-Roberts C, Dye A (1983) Ventilatory effects during and after continuous infusions of fentanyl of alfentanil. Br J Anaesth 55:211s
O'Connor M, Escarpa A, Prys-Roberts C (1983) Ventilatory depression during and after infusion of alfentanil in man. Br J Anaesth 55:217s
Sear JW, Bower S, Potter D (1986) Disposition of alfentanil in patients with chronic renal failure (A.R.S.). Br J Anaesth 58:812
Knaus WA, Draper EA, Draper DP (1984) Apache II: final form and national validation results of a severity of disease classification system. Crit Care Med 12:975
Michiels M, Hendriks R, Heykants J (1984) Radioimmunoassay of the new opiate analgesics alfentanil and sufentanil. Preliminary pharmacokinetic profile in man. J Pharm Pharmacol 35:86
Henschell EO (1977) The Guillain Barré syndrome. A personal experience. Anesthesiology 47:228
Shovelton DS (1979) Reflections of an intensive therapy unit. Br Med J 1:737
Møller IW, Krantz T, Wandall E, Kehlet H (1985) Effect of alfentanil anaesthesia on the adrenocortical and hyperglycaemic response to abdominal surgery. Br J Anaesth 57:591
Stoddart JC, Watson MJ (1983) Etomidate. Lancet 2:168
Drucker D, Shandling M (1985) Variable adrenocortical function in acute medical illness. Crit Care Med 13:477
Cummings JF (1976) The effect of arterial oxygen tension on antipyrine half life in plasma. Clin Pharmacol Ther 19:168
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sinclair, M.E., Sear, J.W., Summerfield, R.J. et al. Alfentanil infusions on the intensive therapy unit. Intensive Care Med 14, 55–59 (1988). https://doi.org/10.1007/BF00254123
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00254123