New narcotics in anesthesia

Recent research has led to the development of a new family of synthetic narcotic fentanyl derivatives. Two of these, sufentanil and alfentanil, are already in clinical use abroad and are presently under clinical investigation in the United States. Sufentanil is more potent than fentanyl and is claimed to have fewer side effects and less variability in patient cardiovascular responses under stress. It appears that its primary application will be for high-dose narcotic anesthesia in patients with cardiovascular disease. Alfentanil has a shorter duration of action and is claimed to have less postoperative ventilatory depression than fentanyl. It is being recommended for use via continuous intravenous infusion. It will probably become a popular anesthetic agent for outpatient and short surgical procedures. It should be remembered that at this time very little information concerning these agents is in print. Most of the research has been done by a handful of investigators and much has not been published in peer review publications. Based on the clinical impressions of our European colleagues, one can say that these agents should be as safe and as reliable as fentanyl, but any clinically significant advantages over their parent compound, especially in the case of sufentanil, will have to await more widespread use and controlled investigation.