جستجوی مقالات مرتبط با کلیدواژه "آلفنتانیل" در نشریات گروه "پزشکی"

Recent studies have shown that anesthetic drugs can cause postoperative shivering. The incidence of postanesthetic shivering varies between 5 and 65% and patients report it as one of the leading causes of discomfort after operation. It may also induce a variety of physiological consequences such as increased O2 consumption and cardiac output. The effect of alfentanil, sufentanil and ketamine on prevention or decrease of postanesthetic shivering is not still clear. This study was performed to find out a suitable alternative for pethidine in prevention of postanesthetic shivering. In this randomized double-blind prospective study, 160 patients were classified into five equal groups according to drugs used for prevention of postoperative shivering after general anesthesia. Alfentanil, sufentanil, ketamine and pethidine groups received the drugs 30 minutes before the end of surgery and were compared with placebo (control group). The primary outcome measures were the incidence and severity of postoperative shivering. The five groups were were not different regarding age, gender, height, weight and the physical status class based on the American Society of Anesthesiologists score. In recovery room, postoperative shivering was seen in 18 patients, 2 in ketamine, 2 in pethidine, 4 in alfentanil, 3 in sufentanil and 7 in placebo group. Fisher’s exact test showed no statistically difference between the groups (P = 0.34). Intravenous infusion of alfentanil, sufentanil and ketamine 30 minutes before the end of surgery effectively reduced the occurrence and severity of postoperative shivering after the general anesthesia, without significant side effects but not as well as pethidine.

Eye movements during opht-halmic surgery cause irreparable complic-ations. So the aim of this study was to com-pare the combined use of fentanyl and pr-opofol versus alfentanil and propofol to limit patient´s eye movement during cataract surgery under topical anesthesia. In this double-blind clinical trial study, patients were randomly divided into two groups. The first Group received Fentanyl 1 µg/kg, and the second one received Alfentanyl 10 µg/kg. Then local anesthesia was done with Tetracaine drops, and cataract surgery was performed by the Phacoemulsification technique. Blood pres-sure and heart rate were measured at the time of injection of anesthesia, and minutes 10 and 30. The rate of eye movement was recorded by an observer surgeon who didn´t know anything about grouping. 246 patients were evaluated. There was no significant difference between blood pressure and heart rate at minutes 10 and 30. Movement of patients´s eye at minutes 10 (Chi-square=0.000001) and 30 (Chi-squ-are=0.000118) was significantly lower in Alfentanyl group than the other one. Discussion & The results of our study showed that Alfentanyl, in comparison with Fentanyl, causes more analgesia, less movments of the patient´s eye, and higher amount of surgeon´s satisfaction.

Pain is a complex medical problem creating which inadequate control pain results adverse effects on the patients physiological, metabolic and mental conditions.The aim of this study was comparison effect of Ketamin-propofol with Alfentanil-propofol on creating analgesia and sedation during cystoscopy and comparing the side effects of two drugs and patient and physician satissfaction. In this double- blind clinical trial 140 person who were candidate for cystoscopy were randomly divided into two groups The first group received 1mcg/kg alfentanil with 1mg/kg propofol and the second group received 0.5 mg/kg ketamin with 1mg/kg propofol. Sedation score, pain score, time of cystoscopy and hemodynamic changes determined and data were analyzed by SPSS. The mean of sedation in alfetanil group was significantly more than ketamin group(p=0.001). The mean of pain score in alfetanil group was significantly less than ketamin group(p=0.001). The time of cystoscopy in cystoscopy in alfetanil group was significantly less than ketamin group (p=0.001). Results showed that alfentanil-propofol compare to ketamin-propofol reduced pain score and increased time of sedation with less side effects during cystoscopy. So this study supports the preference alfentanil compare to ketamin.

Reduction of post-operative nausea and vomiting (PONV)) promotes discharge of patients and reduces healthcare costs, hospital re–admission and duration of stay of patients in hospital, and finally satisfies patients. In this study, the effects of three opioids that are used routinely in general anesthesia (alfentanil, sufentanil and fentanyl) were assessed on the incidence of PONV. In this double-blind clinical trial, one hundred eighty patients (ASA I and II), aged 18-35 year, were randomly allocated into three groups. All three groups were firstly received 1mg midazolam 2minutes before anesthesia and then each group received 2cc of one of following opioid drugs: Alfentanil, fentanyl and sufentail (the general anesthesia method was similar in three groups). PONV was assessed 2hrs and 2-24hrs in post-operative period in these three groups. Incidence of postoperative nausea was respectively 13.33 %, 35% and 41.6% in alfentanil, fentanyl and sufentailgroup in the first 24hrs of post-operative period. Incidence of nausea was significantly lower in alfentanil group in the first 2hrs (p<0.001) and 0-24hrs (p<0.01) in post-operative period. No significant difference was observed in the incidence of vomiting between three groups in 24hrs of post-operative period. Overall, in the first 24hrs post-operative period, there was no difference between the effects of alfentanil, fentanyl and sufentanil on postoperative vomiting, while alfentanil can be consider with lower effects in nausea incidence for post-operative periods

Background and

General anesthesia for oocyte retrieval may interfere with outcomes and success rate of assisted reproductive technology. This study was performed to compare the outcomes of assisted reproductive technology in women regarding recovery time, patient satisfaction and postoperative side effects using remifentanil-propofol and alfentanil-propofol.

We studied 102 women who were scheduled for oocyte retrieval. The patients were randomly allocated into two groups. General anesthesia was performed with remifentanil-propofol (group I) or alfentanil-propofol (group II). The numbers of oocytes collated, fertilized, transferal and pregnancy rate were recorded. Hemodynamic variables, patient satisfaction, recovery time and side effects were also recorded.

There were no significant differences in oocytes collected and pregnancy rates between the two groups. But fertilization was significantly higher in remifentanil-propofol group (P= 0.01). The recovery of patients in remifentanil-propofol was significantly rapid (P= 0.01). Intraoperative hemodynamic parameters, postoperative satisfaction and side effects were found to be similar in both groups.

Remifentanil-propofol is of great benefit in providing an earlier recovery, however, both remifentanil-propofol and alfentanil-propofol regimens are suitable for oocyte retrieval.

Laryngoscopy and tracheal intubation necessitate to start a surgery and induction of general anesthesia as well as the maintenance of the air way and to provide ventilation. However، Laryngoscopy and tracheal intubation may lead to hemodynamic response that appear with the symptoms of hypertension tachycardia، arrhythmia and myocardial ischemia and results in myocardial infarction and CVA. The present clinical trial study compared the effect of two rapid-onset narcotic، remifentanil and alfentanil on the hemodynamic responses to laryngoscopy and tracheal intubation. We studied 80 patients aged 20-50 (ASA I & II) as candidates to elective surgery with general anesthesia. The patients were randomly divided into two groups of 40 with the similar induction. The first group received remifentanil 1µgr/kg and the second group alfentanil 15 µgr/kg one minute before induction. Systolic، diastolic، mean arterial blood pressure and heart rate was measured and recorded before induction، after the injection of drugs، after tracheal intubation، three and five minutes after tracheal intubation. The data were analyzed using descriptive and analytical statistics. Immediately، following the administration of narcotic and induction drug، systolic، diastolic and mean arterial pressure decreased significantly in two groups (p<0. 05)، but، heart rate increased in both groups which this increase was not statistically significant. After laryngoscopy and tracheal intubation all hemodynamic variants (except heart rate) increased (on basic level) and slowly decreased after three minutes in such a way that all hemodynamic variants returned to the level before intubation، in the fifth minute after intubation. Both remifentanil and alfentanil decreased hemodynamic variants due to laryngoscopy and tracheal intubation. These drugs could be used safely to control hemodynamic responses which occur following tracheal intubation

Endotracheal intubation is an essential and important procedure. However, in some conditions such as the presence of difficult intubation, there are some limitations for endotracheal intubation with muscle relaxation.

To compare the effect of propofol-alfentanil with ketamine-alfentanil on endotracheal intubation without muscle relaxation

This was a double-blind clinical trial carried out on 60 patients aged between 18-50 years old. The patients were within the ASA class I-II of anesthesia chosen for elective surgery at Shahid Rajaei Hospital in Qazvin, Iran. The participants were randomly divided into 2 equal groups. For endotracheal intubation without muscle relaxation, one group received propofol-alfentanil and another group ketamine-alfentanil. Changes in hemodynamic parameters (heart rate and blood pressure) and physical findings (vocal cord position, jaw relaxation, ability of mask ventilation, and reaction to endotracheal intubation) were compared between two groups. Data were analyzed with SPSS software using statistical tests including t-test and Chi-square test.

Regarding the hemodynamic parameters, there was significant difference between two groups so that in ketamine group the hemodynamic conditions were more stable than in propofol group (P<0.05). With respect to the physical findings, 93.3% of patients in propofol group were in excellent class and 6.7% in good class whereas in ketamine group 40% were in excellent class, 33.3% in good class, and 26.7% in poor class. Statistically, there was significant difference between two groups (P<0.05).

According to our findings, it seems that the propofol-alfentanil to produce better conditions than the ketamine-alfentanil when performing endotracheal intubation without muscle relaxation.

Propofol is one of the most common drugs used in anesthesia induction and the pain during its intravenous injection is the most important and another side effect of it. Therefore a lot of methods and drugs are examined to reduce or eliminate this side effect. In this study the effects of Alfentanil، Magnesium sulfate and Ketamin drugs on reducing of pain during intravenous injection of propofol are investigated. This study was performed on 220 patients who were under orthopedic surgery in Poursina hospital in 2010. The intensity of propofol intravenous injection pain is measured after using premedication by VAS، result is analyzed by SPSS v16 software under Chi square and PostHoc exams. According to data and variance analysis statistic exam ANOVA it is definded that after propofol injection there is a meaningful difference in quantity of VAS among studied groups (Chi square = 49. 78 and df = 3 and P<0. 0001). The VAS score in Magnesium sulfate group has a meaningful difference in comparison of other groups according to PostHoc exams and there is no meaningful difference among other groups (P>0. 05). Despite reduction the propofol intravenous injection pain in three studies drugs in this thesis، there is no preference among them.

Anesthesia for ophthalmic surgery requires management of intraocular pressure (IOP) during preoperative period. Any degree of IOP increasing could reduce visual acuity. Administration of narcotics concomitant with anesthetics has the ability to reduce this increase of IOP. This clinical trial aims to compare the efficacy of Remifentanil and Alfentanil in preventing an increase in IOP after administration of succinylcholine, intubation and during anesthesia. This double blind clinical trial was intended to 50 patients undergoing elective general surgery for cataracts. Patients were randomly divided to two groups; Alfentanil (20µg/Kg in 30 second) for group 1 and Remifentanil (1µg/kg in 30 second) for group 2 were injected before induction of anesthesia and 0.5µg/kg/min Alfentanil for group 1 and 0.1µg/kg/min Remifentanil for group 2 were infused during the anesthesia. Systolic and diastolic blood pressure, heart rate and IOP from normal eye were measured before the induction, after administration of thiopental and succinylcholine, after tracheal intubation and 2 minutes later and were repeated in 2-minute intervals until the end of operation. IOP decreased after injection of anesthetics and remitted lower all through the operation in both groups, but IOP decreased after injection of succinylcholine in Remifentanil group while it increased in Alfentanil group (P<0.05). Results of this study indicate benefits of both Remifentanil and Alfentanil for managing IOP after induction and during anesthesia. It seems that Remifentanil is better than Alfentanil in controlling the IOP after injection of succinylcholine.

The use of neuraxial opioids has gained popularity over the last few years; they may cause analgesia by the local anesthetic through direct binding with the specific spinal receptors. The purpose of this study was to compare the effect of intrathecal alfentanil in patients undergoing cesarean section on spinal anesthesia during the operation and after the operation on spinal anesthesia and side effects. The study was a randomized prospective and double blind study. 60 young adult females with ASA physical status I and II with singleton pregnancy undergoing elective cesarean section under spinal anesthesia were randomly allocated to receive spinal elective anesthesia either by using 0.5% hyperbaric bupivacaine 2.5 ml with 0.5 ml normal saline (saline group) or with 0.5ml alfentanil (alfentanil group). Blood pressure heart rate respiratory rate oxygen saturation and side effects were observed before spinal anesthesia and every 5 minutes interval during the surgery therefore at 30 minute interval until the patient complained of pain. Intraoprative quality of analgesia during spinal anesthesia time of first feeling of pain (complete analgesia) time of first request of analgesics postoperatively (effective analgesia) side effects (nausea vomiting shivering Purities) and fetal outcomes were evaluated and analyzed. It was shown that 90% of patients in alfentanil group had excellent analgesia Intraopratively while only 16.7% of patients in the saline group had an analgesia which was qualified as excellent (p0/05). The addition of alfentanil 250 micrograms to hyperbaric bupivacaine 12.5mg for spinal anesthesia increased the quality of surgical analgesia and duration of postoperative analgesia in patients undergoing cesarean section without increased any side effects. Purities were the most common side effects but they were mild.

Opioids, such as alfentanil, are used without neuromuscular blocking Javascript:FormatThis('B')agents to facilitate endotracheal intubation in patients undergoing elective surgery. The goal of this study was to evaluate the possibility of endotracheal intubation with propofol and remifentanil and compare it to propofol and alfentanil, without neuromuscular blocking agents. Patients and A hundred ASA I patients undergoing elective inpatient surgery were scheduled in this prospective, randomized, double-blind study. The patients were divided into two groups: alfentanil (control group) and remifentanil (study group). In the control group, 50 μg/kg alfentanil was IV injected over 10 seconds, and after 45 seconds or occurrence of apnea, 2 mg/kg propofol was IV injected over 5 seconds. Thirty seconds after the administration of propofol, laryngoscopy and tracheal intubation were attempted. In the study group, only 5 μg/kg remifentanil was administered instead of alfentanil. Intubating conditions were assessed on the basis of ease of laryngoscopy, vocal cords opening, jaw relaxation, and limb movement (1 - 4 score). Intubation scores were analyzed by nonparametric tests and compared between the two groups. There were no demographic differences such as age,weight and sex between the groups. Although, laryngoscopy, jaw relaxation, and limb movement scores were similar in both groups and there were no significant differences, vocal cord opening was significantly wider in the study group than the control group(P = 0. 028). This study revealed that the use of propofol and remifentanil provided excellent conditions for tracheal intubation in most patients in the same way as propofol and alfentanil, and the score of vocal cord opening in the study group was better than alfentanil group. Therefore, to avoid administering muscle relaxants, remifentanil and propofol can be used for laryngoscopy and endotracheal intubation in healthy young patients.

With consideration the daily increased development of outpatient surgeries and high rate of these operations in elderly patients, rapid and safe recovery of patients for coming back to daily life is necessary. In this clinical trial study recovery time and nausea and vomiting after the use of two rapid-onset narcotic, alfentanil and remifentanil in elderly patients has been compared. In this double-blind clinical trial 40 elderly patients (age above 65) candidated to cataract surgery with general anesthesia were studied. The patients were divided randomly into two groups and for first group alfentanil was injected 10 g/kg and for second group remifentanil 0.5 g/kg during 30 seconds one minute before induction. Both two groups were under general anesthesia with same method and during the anesthesia first group took infusion of alfentanil 1 g/kg/min and second group remifentanil 0.1 g/kg/min. At the end of surgery the time intervals between end of anesthesia drug adminstration and autonomic respiration, eyes opening with stimulation, verbal response and discharge of recovery room, also the incidence of complications related to narcotic drugs especially nausea and vomiting were recorded. The data were analyzed in SPSS software using descriptive and analytical statistics as T-test, chi square and ANOVA. The time of autonomic respiration in alfentanil group was 2 minutes and in remifentanil group 3.3 minutes,this time in alfentanil groupe1.3 minutes shorter but the difference was not significant. The time of eyes opening with stimulation, verbal response and discharge of recovery room were not significantly different. During recovery incidence of nausea and vomiting in remifentanil group (30% of patients) was significantly more than alfentanil group (5% of patients) (P<0.05). The time of recovery between alfentanil and remifentanil group was not significantly different, but incidence of nausea and vomiting in remifentanil group was higher than alfentanil group significantly.

Laryngoscopy and tracheal intubation could lead to hemodynamic responses in the from of hypertension and tachycardia as well as arrhythmia and myocardial ischemia. This alterations can be life-threatening particularly in elderly people. This clinical trial compared the effects of two rapid-onset narcotics, Alfentanil and Remifentanil, on the hemodynamic responses to the induction and tracheal intubation in elderly patients. This double-blind clinical trial was conducted on 40 subjects aged 65 and above. They were candidate of cataract surgery under general anesthesia. The patients were randomly allocated to two groups of 20. The first group, was gaiven Alfentanil 10 m g/kg and for second group Remifentanil 0.5 m g/kg was injected prior to the induction of anesthesia. Both groups were similiar in the method of anesthesia except in narcotics. The first group was infused with Alfentanil 1 m g/kg/min and Remifentanil 0.1 m g/kg/min was used for the second group. Hemodynamic variations including heart rate, systolic, diastolic and mean arterial blood pressure were measured and recorded eight times (before induction, aften injection, after intubation and five times during anesthesia). Data were analyzed with SPSS software using descriptive and analytical statistics such as T-test, chi squre and ANOVA. Immediately after injection of narcotic drugs, all hemodynamic variants decreased. Howerver diastolic blood pressure in Remifentantil group significantly more than Alfentanil group (P<0.05). After laryngoscopy and tracheal intubation all hemodynamic variants increased and slowly decreased in less than 10 minutes. Systolic, diastolic and mean arterial blood pressure decreased significantly in remifentanil group than alfentanil group (P<0.05). Although heart rate decreased during few minutes after intubation, there was not significant difference between two groups regarding this decrease (P>0.05). Ephedrin was used to treat severe hypotention in those under Remifentanil (11 patients) more than those under Alfentanil (4 patients) (P<0.05). According to the resukts of this study Remifentanil could prevent hemodynamic variation induced by laryngoscopy and treacheal intubation more than Alfentanil. However in some cases Remifentanil leads to hypotension during anesthesia. There is no important difference between two drugs in increasing heat rate after laryngoscopy and intubation.

Sympathetic stimulation and pressor responses including tachycardia, hypertension and tachyarrhytmias caused by laryngoscopy and tracheal intubation may result in severe complications in susceptible patients. Opioid anesthetics are one of the several drugs used to attenuate this response but prolonged postoperative respiratory depression is the major complication distracting from their high dose administration which is nceded for complete amelioration of pressor response. In this study Alfentanyl, as a rapid acting and short duration opioid (without prolonged respiratory depression), was used in two different dosages for controlling of pressor response.

In a single blind, controlled clinical trial, 236 patients in the range of 18 to 70 years old), whom needing laryngoscopy and tracheal intubation were selected and randomly divided into two equal groups. First group received low (current) dose (15u gr/kg) Alfentanyl, and the other received high dose (450gr/kg), prior to laryngoscopy and tracheal intubation. Type and dosage of induction drugs were the same and matched in both groups. Blood pressure and heart rate were measured before intravenous induction and after intubation of the tracheal in all patients. Mercurial sphygmomanometer and pulse oximeter were used for these measurements. Incidence of such complications as hypotention, muscle stiffness and neurologic hyper reactivity, were also measured. Data were analysed by Z distribution and Chi square tests.

Alfentanyl was cffective in controlling pressor response in both groups. In the case of heart rate, the mean difference between two groups was not significant. There was a significant difference mean arterial pressure between two groups (p<0.05). In high dose group, incidence of complications was higher for severe hypotension (p<0.05), stiff chest syndrome (p<0.05), and neurologic hyperreactivity (p<0.05).

High dose of Alfentanyl is more efficient in controlling of pressor response than low dose of the drug. High dose administration also may results in some complications. In this study current dose of Alfentanyl is recommended for controlling of pressor response, but high dose may be used with some modification in the dose of induction agents.