Is alfentanil by infusion useful for sedation on the ITU?

Methods of sedation in the ITU have changed considerably over the last few years. Whereas the use of muscle relaxants to control ventilation was a frequent feature of those ITUs reviewed by Merriman, a more recent study by Gast and colleagues revealed a far greater use of narcotics and/or hypnotics, or combinations of the two. Alfentanil has many of those ideal properties needed of a sedative drug in the ITU--its use is associated with marked cardiovascular stability, it is a potent ventilatory depressant, has a high therapeutic ratio, minimal immunological or metabolic effects, and has an appropriate kinetic profile (low liposolubility, small volume of distribution, short half-life). The present paper describes the use of an infusion of alfentanil, in combination with increments of midazolam, to provide sedation and control of ventilation in patients admitted to a general ITU.