Is sufentanil a useful opioid for laryngomicroscopy?

Alfentanil is commonly used as opioid analgesic for short surgical procedures. Little is known about the usefulness of sufentanil for this purpose. We investigated the effects of alfentanil and sufentanil on haemodynamic characteristics, catecholamine levels, and adrenocorticotropic hormone (ACTH) and cortisol contents during elective laryngomicroscopy and short laryngeal surgery (LM).

100 patients (ASA class I or II) were randomly allocated into one of four groups to receive either 10 micrograms/kg alfentanil (group I, ALF 10), 20 micrograms/kg alfentanil (group II, ALF 20), 0.25 micrograms/kg sufentanil (group III, SUF 0.25), or 0.5 micrograms/kg sufentanil (group IV, SUF 0.5) given intravenously before induction of anaesthesia. After administration of the opioid analgesic all patients received 2.0 mg/kg propofol, 15 micrograms/kg vecuronium, and 1 mg/kg succinylcholine. Anaesthesia was maintained as total intravenous anaesthesia with propofol (8 mg/ kg/h) and oxygen (33%) in air. Heart rate (HR), mean arterial pressure (MAP), adrenaline (ADR), noradrenaline (NADR), ACTH, and cortisol were measured before (baseline) and after induction of anaesthesia, at the beginning and cessation of LM, and 2 h after LM.

In group I (ALF 10) a significant increase in all variables was observed at the beginning and at the end of LM when compared with baseline. Two hours after LM all parameters were found to be at baseline levels. In groups II and III (ALF 20 and SUF 0.25) a significant increase in HR, MAP and catecholamine levels was observed at the end of LM compared to baseline. ACTH and cortisol contents were unchanged throughout. In group IV (SUF 0.5) HR was significantly reduced after induction, at the beginning and cessation of LM, and 2 hours following operation, whereas MAP was only decreased after induction (P < 0.05 vs. baseline). ADR, NADR, ACTH, and cortisol were similar throughout. If the duration of surgery was shorter than 12 min (20%) in group III (SUF 0.25) and 20 min (44%) in group IV (SUF 0.5), the patients had to be treated with naloxone 10 min after cessation of LM in order to antagonize respiratory depression. This side effect was not observed in group I (ALF 10) and in only one patient (4%) of group II (ALF 20) for whom surgery lasted 5 min.

Clinical recovery is achieved most rapidly with alfentanil in ultra short surgical procedures. However, if surgery is expected to be longer than about 12 min also sufentanil at a dose of 0.25 micrograms/kg seems to be useful for this kind of surgery.