Monitored anesthetic care for outpatient cataract surgery with alfentanil

Alfentanil, a short-acting congener of fentanyl, was studied as an analgesic sedative in monitored anesthetic care for outpatient cataract surgery with the intent of investigating efficacy in this setting and establishing dosage guidelines. Nineteen outpatients were studied, all of whom received droperidol 0.625 mg and midazolam 0.5 to 1.0 mg prior to a bolus dose of alfentanil preceding the administration of local anesthetic facial nerve and retrobulbar blocks. Alfentanil was titrated to achieve patient comfort during block administration, and sedatives were repeated as necessary intraoperatively. A mean alfentanil dose of 8.9 micrograms/kg was found to be effective. Eighteen patients (94%) rated the discomfort of local anesthetic blocks as absent or mild, and only 1 patient (5%) rated the blocks as severely painful. No severe cardiorespiratory or central nervous system side effects were observed, and 15% of patients were nauseated postoperatively despite droperidol administration. It can be concluded that alfentanil is an effective sedative in outpatient cataract surgery with minimal side effects reported in this clinical study.