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[The use of alfentanil for short duration surgery in pediatric anesthesia]
P Orfei1, E Bigetti, A Patrizio
1Istituto di Anestesiologia e Rianimazione, Università degli Studi di Roma La Sapienza, Roma. p.orfei@mclink.it
Background:
In the present paper, the effectiveness of the alfentanyl-propofol combination versus fentanyl-propofol association in pediatric anesthesia during short surgical procedures was investigated.
Experimental Design:
randomized study.
Setting:
This study was carried out at the Surgical-Division of the Pediatric Clinic of the University "La Sapienza", Rome.
Patient:
100 children (age 4.95 +/- 0.26 yr, body weight 21.13 +/- 0.86 kg) undergone to short anesthesia (50 +/- 0.01 min), were examined. PATIENTs were divided randomly into two groups, A and B, each composed of 50 children. PATIENTs in group A received an alfentanyl bolus dose of 50 micrograms.kg-1 and a continuous infusion of 0.50 microgram.kg-1.min-1, whereas patients in group B received a fentanyl bolus dose of 5 micrograms.kg-1 and a continuous infusion of 0.16 microgram.kg-1.min-1. In all patients, propofol was given in the same dose (bolus dose 1 mg.kg-1; continuous infusion 0.1 mg.kg-1.min-1) in association with opioid analgesic.
Measurements:
non-invasive arterial pressure, EKG, heart rate, rectal temperature, oxygen saturation, capnography; during the postoperative course, we evaluated the motor activity response, the degree of weakfulness and consciousness.
Results:
No significant differences between two groups in the systolic, diastolic and mean arterial pressure were pointed out whereas a decrease in heart rate in the group B and a better and more rapid restoration of breathing in group A was observed. Children of group A, after awakening, were more quiet and answered more readily to simple orders (64%). In group B 50% of children showed psychomotor unrest and 10% of them cried. The group that received alfentanyl answered more readily than group B (42% versus 26%).
Conclusions:
The present study shows that alfentanyl allows a better control of the surgical analgesia and it assures a good analgesic cover for all short surgical procedures without risk of early respiratory depression in postoperative period. Furthermore alfentanyl assures an early postoperative recovery due to the minimal pool, minimal undesired effects, and a cardiocirculatory stability.