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Injection pain intubating conditions and cardiovascular changes following induction of anesthesia with propofol alone or in combination with alfentanil

Injection pain intubating conditions and cardiovascular changes following induction of anesthesia with propofol alone or in combination with alfentanil

Acta Anaesthesiologica Scandinavica 35(1): 19-23

In a double-blind study, propofol (P) 2-2.5 mg .cntdot. kg-1 preceded by saline (Sal) or alfentanil (A) 20-30 .mu.g .cntdot. kg-1 was used for anaesthetic induction in 59 young patients of ASA physical class I or II, premedicated with oxycodone 0.1 mg .cntdot. kg-1 and atropine 0.01 mg .cntdot. kg-1 i.m. The patients were randomly allocated to one of the four groups: Group 1 Sal + P2.5, Group 2 A20 + P2.5, Group 3 A30 + P2.5 and Group 4 A30 + P2. Pain on injection of propofol occurred in 67, 36 and 7% of the patients in the Sal + P2.5, A20 + P2.5 and A30 + P2 groups, respectively, but not at all in the A30 + P2.5 group. Intubating conditions were assessed as good, moderate, poor or impossible on the basis of jaw relaxation, ease of insertion of the tube and coughing on intubation, each on a three-point scale. In impossible cases, suxamethonium was used. In the Sal + P2.5 group, the frequencies of good, moderate, poor and impossible intubating conditions were 0, 38, 8 and 54%, respectively. The corresponding figures in the A30 + P2.5 group were 43, 46, 7 and 14% (P < 0.05 between the groups). The other groups did not differ significantly from the Sal + P2.5 group. After injection of propofol, both systolic and diastolic arterial pressures decreased significantly in all other groups, with the exception of diastolic pressure in the Sal + P2.5 group, whereas heart rate did not differ from the control level. After intubation, systolic arterial pressure increased statistically significantly in the Sal + P2.5 and A30 + P2 groups and diastolic arterial pressure in all other groups with the exception of the A30 + P2.5 group when compared with the corresponding preceding values. After intubation, heart rate decreased significantly in the A30 + P2.5 and A30 + P2 groups. The mean QTc interval of the ECG was always in the normal range. It is concluded that the best method was the combination of alfentanil 30 .mu.g .cntdot. kg-1 and propofol 2.5 mg .cntdot. kg-1. It caused no pain on injection of propofol, offered satisfactory (good or moderate) intubating conditions in 79% of the patients and prevented the cardiovascular intubation response.

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Accession: 007468217

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PMID: 2006594

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