Does alfentanil preserve left ventricular pump function during rapid sequence induction of anaesthesia?

Area of Science:

• Anesthesiology
• Cardiovascular Physiology
• Pharmacology

Background:

• Rapid sequence induction (RSI) of general anesthesia involves potent stimuli.
• These stimuli can trigger significant hemodynamic and neuroendocrine responses.
• Managing these responses is crucial for patient safety.

Purpose of the Study:

• To evaluate the impact of alfentanil on circulatory and catecholamine responses during RSI.
• To assess alfentanil's effect on left ventricular ejection fraction during RSI.

Main Methods:

• A double-blind, randomized trial involving 24 patients without cardiopulmonary disorders.
• Patients received either alfentanil (100 mcg/kg IV) or saline before thiopentone and suxamethonium induction.
• Hemodynamic parameters, plasma catecholamines, and left ventricular ejection fraction were measured.

Main Results:

• Alfentanil significantly blunted the hypertensive and tachycardic responses to laryngoscopy and intubation.
• Plasma noradrenaline and adrenaline levels were markedly reduced in the alfentanil group.
• Left ventricular ejection fraction remained unchanged with alfentanil, unlike the saline group which showed a decrease.
• Moderate hypotension was observed in the alfentanil group.

Conclusions:

• Alfentanil (100 mcg/kg IV) effectively attenuates hemodynamic and catecholamine surges during RSI.
• It preserves left ventricular ejection fraction, but can lead to hypotension.
• Alfentanil is a viable option for blunting stress responses in RSI, with careful monitoring for hypotension.