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Canadian Journal of Anesthesia, Vol 30, 53-60, Copyright © 1983 by Canadian Anesthesiologists' Society

Anaesthetic Induction with Alfentanil: Comparison with Thiopental, Midazolam, and Etomidate

JELLE NAUTA MD1, THEODORE H. STANLEY MD1, SIMON DE LANGE MD FFARCS1, DAVID KOOPMAN MD1, JOHAN SPIERDIJK MD PH D1, and JACK VAN KLEEF MD1

1 Departments of Anesthesiology, The University of Utah School of Medicine, Salt Lake City, Utah, and The University of Leiden, Leiden, The Netherlands

Address Correspondence to: Theodore H. Stanley, MD, Department of Anesthesiology, The University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, Utah 84132.

The speed, side effects and cardiovascular changes associated with anaesthetic induction and endotracheal intubation following alfentanil (20 µg/kg/min, IV), thiopental (84 µg/kg/min, IV), etomidate (5 µg/kg/min, IV) and midazolam (20 µg/kg/min, IV)prior to halothane-nitrous oxide general anaesthesia were evaluated and compared in 80 patients undergoing elective general surgical operations. Anaesthetic induction was fastest with etomidate and thiopental (approximately one minute) and slowest with midazolam (about two minutes). Systolic arterial blood pressure (SBP) was decreased at the moment of unconsciousness with thiopental but unchanged with the other compounds. Heart rate (HR) was increased at unconsciousness with midazolam and thiopental but unchanged with etomidate and alfentanil. After intubation HR was increased in all groups except those induced with alfentanil. Arrhythmias were infrequent (5 per cent or less in all groups). Rigidity during induction only occurred with alfentanil (55 per cent) and pain on injection only with etomidate (35 per cent) and alfentanil (5 per cent). Postoperative vomiting was infrequent in all groups (15 per cent) except etomidate (55 per cent). No patient remembered any aspect of laryngoscopy or the operation and all rapidly regained consciousness at the end of operation. The results of this study demonstrate that with the exception of rigidity (which is easily overcome with succinylcholine) and a slightly slower onset of action, alfentanil compares favourably as an induction agent with thiopental and is better than midazolam and etomidate. Alfentanil is superior to all three other induction agents with respect to cardiovascular stability during induction and intubation.

Key Words: ANAESTHETICS, INTRAVENOUS: alfentanil • thiopental • midazolam • etomidate • INDUCTION: anaesthesia






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Copyright © 1983 by the Canadian Anesthesiologists' Society.