[Alfentanil as the last dose (on top) in neuroleptanesthesia with fentanyl. Pharmacokinetics and pharmacodynamics with reference to the cortical effect]. 1986

E Freye, and E Hartung, and R Buhl

Due to its predictable duration of action, its low volume of distribution in the organism (muscle, fat tissue, skin) and a corresponding low terminal elimination half life (t 1/2 beta), alfentanil seems suitable for use as the last dose of opioid given during NLA. In order to compare the efficacy of this regimen, patients (n = 10) during routine-NLA (induction 0.3 mg/kg etomidate, 140 micrograms/kg droperidol, 5 micrograms/kg fentanyl with a maintenance dose of 2 micrograms/kg when necessary and mechanical N2 O/O2 = 2:1 ventilation) received alfentanil (20 micrograms/kg) as the last opioid, while another set of patients (n = 5) received fentanyl (1.5 micrograms/kg). For recording of vigilance continuous EEG power spectra were derived (position Fpz--C3), and in addition minute volume was monitored postoperatively. After the last dose of the opioid, alfentanil--and fentanyl--blood plasma levels were determined every 10 min over a period of 100 min Vigilance, i.e. the sensitivity of the organism in responding to a stimulus, was significantly higher in the "on-top"-alfentanil group. This was derived from the high power in fast frequency domains, beta (greater than 460%) and alpha (greater than 34%) compared to routine NLA in the post op. period. No significance was observed among both groups in regard to postop. respiratory minute volumes and fentanyl plasma levels. There was no correlation between power in the various frequency bands (delta, theta, alpha and beta), postoperative respiratory minute volumes and corresponding plasma levels of fentanyl. Due to a higher state of postoperative vigilance, alfentanil is considered a suitable alternative as the last opioid during narcotic anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009458 Neuroleptanalgesia A form of analgesia accompanied by general quiescence and psychic indifference to environmental stimuli, without loss of consciousness, and produced by the combined administration of a major tranquilizer (neuroleptic) and a narcotic. Neuroleptoanalgesia
D012123 Pulmonary Ventilation The total volume of gas inspired or expired per unit of time, usually measured in liters per minute. Respiratory Airflow,Ventilation Tests,Ventilation, Pulmonary,Expiratory Airflow,Airflow, Expiratory,Airflow, Respiratory,Test, Ventilation,Tests, Ventilation,Ventilation Test
D002540 Cerebral Cortex The thin layer of GRAY MATTER on the surface of the CEREBRAL HEMISPHERES that develops from the TELENCEPHALON and folds into gyri and sulci. It reaches its highest development in humans and is responsible for intellectual faculties and higher mental functions. Allocortex,Archipallium,Cortex Cerebri,Cortical Plate,Paleocortex,Periallocortex,Allocortices,Archipalliums,Cerebral Cortices,Cortex Cerebrus,Cortex, Cerebral,Cortical Plates,Paleocortices,Periallocortices,Plate, Cortical
D004569 Electroencephalography Recording of electric currents developed in the brain by means of electrodes applied to the scalp, to the surface of the brain, or placed within the substance of the brain. EEG,Electroencephalogram,Electroencephalograms
D005071 Evoked Potentials Electrical responses recorded from nerve, muscle, SENSORY RECEPTOR, or area of the CENTRAL NERVOUS SYSTEM following stimulation. They range from less than a microvolt to several microvolts. The evoked potential can be auditory (EVOKED POTENTIALS, AUDITORY), somatosensory (EVOKED POTENTIALS, SOMATOSENSORY), visual (EVOKED POTENTIALS, VISUAL), or motor (EVOKED POTENTIALS, MOTOR), or other modalities that have been reported. Event Related Potential,Event-Related Potentials,Evoked Potential,N100 Evoked Potential,P50 Evoked Potential,N1 Wave,N100 Evoked Potentials,N2 Wave,N200 Evoked Potentials,N3 Wave,N300 Evoked Potentials,N4 Wave,N400 Evoked Potentials,P2 Wave,P200 Evoked Potentials,P50 Evoked Potentials,P50 Wave,P600 Evoked Potentials,Potentials, Event-Related,Event Related Potentials,Event-Related Potential,Evoked Potential, N100,Evoked Potential, N200,Evoked Potential, N300,Evoked Potential, N400,Evoked Potential, P200,Evoked Potential, P50,Evoked Potential, P600,Evoked Potentials, N100,Evoked Potentials, N200,Evoked Potentials, N300,Evoked Potentials, N400,Evoked Potentials, P200,Evoked Potentials, P50,Evoked Potentials, P600,N1 Waves,N2 Waves,N200 Evoked Potential,N3 Waves,N300 Evoked Potential,N4 Waves,N400 Evoked Potential,P2 Waves,P200 Evoked Potential,P50 Waves,P600 Evoked Potential,Potential, Event Related,Potential, Event-Related,Potential, Evoked,Potentials, Event Related,Potentials, Evoked,Potentials, N400 Evoked,Related Potential, Event,Related Potentials, Event,Wave, N1,Wave, N2,Wave, N3,Wave, N4,Wave, P2,Wave, P50,Waves, N1,Waves, N2,Waves, N3,Waves, N4,Waves, P2,Waves, P50
D005283 Fentanyl A potent narcotic analgesic, abuse of which leads to habituation or addiction. It is primarily a mu-opioid agonist. Fentanyl is also used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1078) Phentanyl,Duragesic,Durogesic,Fentanest,Fentanyl Citrate,Fentora,R-4263,Sublimaze,Transmucosal Oral Fentanyl Citrate,R 4263,R4263
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000768 Anesthesia, General Procedure in which patients are induced into an unconscious state through use of various medications so that they do not feel pain during surgery. Anesthesias, General,General Anesthesia,General Anesthesias
D001143 Arousal Cortical vigilance or readiness of tone, presumed to be in response to sensory stimulation via the reticular activating system. Vigilance, Cortical,Arousals,Cortical Vigilance

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