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Alfentanil-induced rigidity in newborn infants
M L Pokela1, P T Ryhänen, M E Koivisto
1Department of Pediatrics, University of Oulu, Finland.
Anesthesia and Analgesia
|August 1, 1992
Summary
Alfentanil administration in critically ill neonates may cause muscle rigidity, potentially impairing ventilation and oxygenation. This study suggests alfentanil should not be used in newborns without concurrent muscle relaxation.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Critical Care
Background:
- Critically ill neonates often require procedural sedation.
- Alfentanil is a short-acting opioid analgesic used for procedural sedation.
Purpose of the Study:
- To evaluate the safety and efficacy of alfentanil for procedural sedation in critically ill, mechanically ventilated neonates.
- To assess the pharmacokinetic profile and adverse effects of alfentanil in this population.
Main Methods:
- Twenty mechanically ventilated neonates received intravenous alfentanil (11.7 mcg/kg) before procedures within the first 3 days of life.
- Hemodynamic parameters, oxygenation, and activity were continuously monitored.
- Plasma alfentanil concentrations were measured in 15 subjects.
- Electroencephalographic (EEG) recordings were performed in three infants.
Main Results:
- Hemodynamic changes were not clinically significant.
- The primary adverse effect was muscle rigidity, ranging from mild to severe.
- Four infants experienced severe rigidity and jerking, transiently impairing ventilation and oxygenation, requiring increased oxygen and manual ventilation.
- EEG showed no increased seizure activity.
- Pharmacokinetics varied significantly among neonates.
Conclusions:
- Alfentanil administration in critically ill neonates can lead to significant muscle rigidity.
- The risk of rigidity necessitates concurrent muscle relaxation when using alfentanil in this population.
- Further research into safer sedation strategies for neonates is warranted.