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Alfentanil in infants and children with congenital heart defects
J M den Hollander1, P J Hennis, A G Burm
1Department of Anesthesiology, University Hospital Leiden, The Netherlands.
Insights
Alfentanil infusion effectively supplemented anesthesia for pediatric heart surgery, showing adequate control and no need for naloxone. Pharmacokinetics were analyzed in infants and children, with clearance rates determined.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacokinetics
Background:
- Congenital heart defects require complex surgical interventions.
- Anesthesia management in infants and children presents unique challenges.
- Alfentanil is a potent opioid analgesic used in anesthesia.
Purpose of the Study:
- To evaluate the efficacy of alfentanil infusion as an anesthetic supplement in pediatric cardiac surgery.
- To determine the pharmacokinetics of alfentanil in infants and children undergoing these procedures.
Main Methods:
- Eleven patients (6 infants, 5 children) received nitrous oxide-halothane anesthesia supplemented with alfentanil infusion.
- Alfentanil plasma concentrations were measured via gas chromatography during and after surgery.
- Pharmacokinetic parameters were calculated using standard analytical methods.
Main Results:
- Alfentanil provided adequate anesthesia during and after cardiopulmonary bypass.
- Heart rate decreased in infants, and blood pressure decreased in older children post-alfentanil administration.
- All patients were extubated quickly without requiring naloxone or experiencing respiratory depression.
Conclusions:
- Alfentanil infusion is a safe and effective anesthetic supplement for pediatric congenital heart defect surgery.
- The pharmacokinetic profile of alfentanil in this population supports its clinical use.
- This anesthetic strategy facilitates timely extubation and avoids postoperative respiratory complications.
Abstract:
The use of an alfentanil infusion as a supplement to a nitrous oxide-halothane anesthetic and the pharmacokinetics of alfentanil were evaluated in infants and children undergoing surgery for correction of congenital heart defects. Eleven patients, six infants and five children, were studied. Anesthesia was induced with nitrous oxide-halothane and pancuronium, 0.15 mg/kg. After intubation, anesthesia was maintained with nitrous oxide-oxygen and halothane to a maximum inspired concentration of 0.6%. After administration of atropine, 20 micrograms/kg, alfentanil, 20 micrograms/kg, was given, followed by a continuous infusion of 1 microgram/kg/min, which was stopped after closure of the sternum. Supplemental boluses of alfentanil, 5 micrograms/kg, were given when, during surgery, blood pressure and/or heart rate increased more than 20% above control values. At the end of surgery, after antagonism of residual neuromuscular blockade, the patients were extubated. Arterial blood samples were collected at regular intervals during surgery and for six hours thereafter for determination of alfentanil plasma concentrations by gas chromatography. Pharmacokinetic data were calculated using the method of residuals and noncompartmental moment analysis. Although atropine was administered, heart rate decreased significantly (2.5% to 15%) in all infants after administration of alfentanil. In the older children, blood pressure decreased 10% to 35%. In the period before bypass, three infants and four children needed supplemental boluses of alfentanil. During and after bypass, anesthesia was adequate. All patients could be extubed within 34 minutes of stopping the alfentanil infusion. Naloxone was not required in any patient, and postoperative respiratory depression did not occur. In the infants and children, total plasma clearance was 8.2 +/- 2.2 mL/kg/min and 6.3 +/- 0.8 mL/kg/min, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)