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Alfentanil infusion for sedation in infants and small children during cardiac catheterization
1Department of Anaesthesia, Children's Hospital, University of Helsinki, Finland.
Insights
Alfentanil infusion provides effective sedation for pediatric cardiac catheterization, maintaining spontaneous breathing. Doses were lower in cyanotic patients, indicating tailored sedation is feasible.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Pharmacology
Background:
- Pediatric cardiac catheterization requires stable sedation while preserving spontaneous breathing.
- Various sedation techniques exist, but optimal methods are continuously sought.
Purpose of the Study:
- To evaluate the efficacy and safety of an individually titrated alfentanil infusion for sedation during pediatric cardiac catheterization.
- To assess if alfentanil infusion can maintain stable conditions and spontaneous respiration for the procedure.
Main Methods:
- 14 infants (1-17 months) received oral flunitrazepam premedication.
- Sedation was achieved using an individually titrated intravenous infusion of alfentanil.
- Sedation levels were monitored to ensure no reaction to pain or discomfort.
Main Results:
- Alfentanil induction dose averaged 24 ± 8 µg/kg, with a maintenance requirement of 32 ± 8 µg/kg/hr.
- Lower doses were required in cyanotic patients compared to acyanotic patients (P < 0.05).
- Mean plasma alfentanil concentration was 79 ± 23 ng/mL; two patients required brief ventilatory assistance.
Conclusions:
- Alfentanil infusion is a practical and effective sedation method for pediatric cardiac catheterization.
- Close monitoring of respiratory function is essential when using alfentanil for sedation.
- The technique allows for stable conditions and maintenance of spontaneous breathing during the procedure.
Abstract:
We have analyzed several sedation techniques for paediatric cardiac catheterization which offer stable conditions for a few hours investigation, and maintain spontaneous breathing. In the present study, after premedication with oral flunitrazepam 0.1 mg.kg-1, 14 children aged 1-17 mo were sedated with an individually titrated alfentanil infusion. Every patient was sedated to a level which produced no reaction to pain or any discomfort. The induction dose and the maintenance requirement of alfentanil were 24 +/- 8 micrograms.kg-1 and 32 +/- 8 micrograms.kg-1.hr-1 (mean +/- SD), respectively. These doses were less in cyanotic than in acyanotic patients: 21 +/- 6 vs 28 +/- 8 micrograms.kg-1 and 29 +/- 10 vs 34 +/- 3 micrograms.kg-1.hr-1, respectively (P less than 0.05). The mean plasma concentration of alfentanil during maintenance of sedation was 79 +/- 23 ng.ml-1. Ventilation of two children was assisted for a short time after an incremental bolus of alfentanil. It is concluded that an alfentanil infusion technique with close monitoring of breathing is a practical sedation method for paediatric cardiac catheterization.