ALFENTANIL SUPPRESSES COUGHING AND AGITATION DURING EMERGENCE FROM ISOFLURANE ANESTHESIA

Study Objective: To evaluate the effectiveness of alfentanil in suppre ssing coughing and agitation during emergence from isoflurane anesthes ia. Design: Randomized, double-blind, placebo-controlled study. Settin g: Operating rooms at a university medical center. Patients: 34 health y ASA physical status I and II adult patients scheduled to undergo ora l surgical procedures. Interventions: During emergence from anesthesia , patients received either alfentanil 15 mu g/kg (in 10 ml) or saline (10 ml) when the end-tidal isoflurane concentration reached 0.3%. Meas urements and Main Results: Hemodynamic variables were measured at one- minute intervals following administration of the study medication. A b linded observer recorded the time for patients to spontaneously open t heir eyes and to follow commands after discontinuing the isoflurane. T he occurrence of coughing and agitation prior to extubation was noted. Patients in the alfentanil treatment group exhibited a reduced incide nce of coughing prior to extubation (6% vs. 83%, respectively) and a l onger time interval until the onset of spontaneous movements (21.1 +/- 2.6 min vs. 14.6 +/- 1.7 min, respectively). The interval between the onset of movement and orientation was shorter in the alfentanil-treat ed patients, resulting in similar extubation times for both groups. Al fentanil administration was also associated with lower heart rate, sys tolic diastolic, and mean arterial pressure values during the emergenc e period. Conclusion: Alfentanil decreased coughing, agitation, and ca rdiovascular stimulation during emergence from isoflurane anesthesia w ithout prolonging the time to extubation.