Continuous alfentanil infusion for extracorporeal shock wave lithotripsy of gallbladder stones

Extracorporeal shock wave lithotripsy has recently been introduced in clinical trials for the treatment of cholelithiasis. General anesthesia, epidural anesthesia, and intravenous opiates have been used in the anesthetic management of patients undergoing this procedure. This report details our anesthetic management, which was used in 23 patients who underwent 27 procedures, and presents three illustrative cases. A continuous infusion of alfentanil and a 0.625-2.5-mg dose of droperidol were administered to the patients who were easily arousable during the procedure, and were able to cooperate with positioning change requests. Our patients did not develop apnea, hemodynamically significant bradycardia, or chest wall rigidity. One patient became nauseated, and one patient experienced a hypotensive episode that was unheralded by a change in respiratory rate, heart rate, or oxygen saturation. The patients were comfortable throughout the procedure, alert upon arrival to the postanesthesia care unit, and satisfied with this technique. A continuous infusion of alfentanil can be successfully used for the management of patients undergoing biliary lithotripsy.