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British Journal of Anaesthesia, 2002, Vol. 88, No. 3 430-433
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Short Communications

Effects of remifentanil and alfentanil on the cardiovascular responses to induction of anaesthesia and tracheal intubation in the elderly

A. S. Habib, J. L. Parker, A. M. Maguire, D. J. Rowbotham and J. P. Thompson*

University Department of Anaesthesia, Critical Care and Pain Management, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK*Corresponding author

Background. We compared the effects of remifentanil and alfentanil on arterial pressure and heart rate at induction of anaesthesia and tracheal intubation in 40 ASA I–III patients aged greater than 65 yr, in a randomized double-blind study.

Methods. Patients received either remifentanil 0.5 µg kg–1 over 30 s, followed by an infusion of 0.1 µg kg min–1 (group R) or alfentanil 10 µg kg–1 over 30 s, followed by an infusion of saline (group A). Anaesthesia was then induced with propofol, rocuronium, and 1% isoflurane with 66% nitrous oxide in oxygen.

Results. Systolic arterial pressure (SAP) and mean arterial pressure (MAP) decreased after the induction of anaesthesia (P<0.05) and increased for 3 min after intubation in both groups (P<0.05), but remained below baseline values throughout. Heart rate remained stable after induction of anaesthesia but increased significantly from baseline after intubation for 1 and 4 min in groups R and A, respectively (P<0.05). There were no significant between-group differences in SAP, MAP, and heart rate. Diastolic pressure was significantly higher in group A than group R at 4 and 5 min after intubation (P<0.05). Hypotension (SAP <100 mm Hg) occurred in four patients in group R and three patients in group A.

Conclusions. Remifentanil and alfentanil similarly attenuate the pressor response to laryngoscopy and intubation, but the incidence of hypotension confirms that both drugs should be used with caution in elderly patients.

Br J Anaesth 2002; 88: 430–3


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