Alfentanil anaesthesia in gall-bladder surgery

Five different dosage schemes for alfentanil administration supplemented with thiopentone, pancuronium and N2O/O2 have been studied in 25 patients undergoing elective cholecystectomy. Six patients in the high dosage group experienced stiff chest during induction and five patients developed respiratory arrest on the recovery ward. The effects of the different schedules in blocking the surgical stress response have been elucidated by serial measurements of serum cortisol and glucose, heart rate and systolic blood pressure. There were no significant changes in serum cortisol, heart rate and blood pressure during anaesthesia and surgery in any group. All patients showed a significant increase in serum cortisol 2 h postoperatively. There was significant elevation of serum glucose after 1 h of surgery in two groups (maintenance dose 1 microgram/kg/min of alfentanil) and in all groups except one (maintenance dose 3.0 micrograms/kg/min) 2 h postoperatively. High dosage of alfentanil resulted in frequent stiff chest during induction and respiratory arrest postoperatively. High dosage did not seem to give any additional benefits in blocking the surgical stress response in this type of surgery.