Alfentanil administered prior to endotracheal suctioning reduces cerebral perfusion pressure

The effects of i.v. alfentanil on the intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were prospectively evaluated during endotracheal suctioning of head-injured adults. Seven subjects underwent trials of saline and alfentanil at 15 and 30 micrograms/kg prior to a stereotypic stimulus of endotracheal suctioning. Investigators and medical personnel were blinded with respect to the intravenous substance administered. The ICP, mean arterial pressure (MAP), heart rate (HR), peak and plateau inspiratory pressures, and Glasgow Coma Scores were recorded. By analysis of variance with repeated measures, data demonstrated that the alfentanil trials were associated with a decline in the CPP relative to control. The CPP was significantly reduced (p < 0.05) in the alfentanil dosage trials 5 min after i.v. alfentanil injection. There was no evidence of alteration of chest wall compliance to explain apparent elevations in the ICP or reductions in the MAP. These findings suggest caution in the use of alfentanil in the neurotrauma patient. Potential mechanisms of reduction in cerebral perfusion will require further evaluation. Formal assessment of other synthetic opiates with respect to efficacy and safety in the neurotrauma patient is advised.