[Intravenous combination anesthesia using alfentanil in infants]

Intravenous anesthesia is a method rarely used during infancy. Only neuroleptanalgesia has a number of indications, especially in major surgery and for seriously ill children. There are several advantages of inhalation anesthesia in infancy: good control of anesthesia because of low fat-muscle mass, low functional residual capacity, relatively increased alveolar ventilation, and increased cardiac output. Potential disadvantages of inhalation anesthesia in infancy are numerous: The necessity of high concentrations of inhalational agents may cause myocardial depression and blood pressure drops, the analgetic potency is very low, damage to surfactant is possible, there is a prolonged awakening period in many cases, and cerebral blood flow and intracranial pressure can be increased by inhalation anesthetics. Positive results with the short-acting opiate alfentanil in adult lead us to the idea of replacing routine inhalation anesthesia by a combination of low-dose halothane and intermittent injections of alfentanil. Fifty infants undergoing corrective orthopedic surgery of the hip and lower limb were anesthetized with the combination of alfentanil and halothane described in Fig. 1. Patient data are shown in Table 2. All children were premedicated orally with flunitrazepam 0.1 mg/kg body weight and Bellafolin 1 drop/kg and were primarily anesthetized via inhalation of oxygen/N2O/halothane. After relaxation with vecuronium, intubation and administration of alfentanil, halothane concentrations were reduced to low maintenance doses. Intraoperative und postoperative circulatory parameters showed remarkable stability. Postoperative blood gas analyses--in 8 cases done using capillary blood--gave no hint of any respiratory or metabolic disorder caused by the anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)