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Svæfingar smábarna með alfentanil

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Authors
Gísli Vigfússon
Reinhold, Paul
Zander, Josef
Issue Date
1988-11-15

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Citation
Læknablaðið 1988, 74(9):367-70
Abstract
In the last few years new opiates have been introduced, having less side effects than the old narcotics. This is true during anaesthesia and even more so in the recovery period. Fewer side effects relate to shorter half life and a smaller volume of distribution. This makes it easier to control depth of anaesthesia and shortens the recovery period. One of these drugs is alfentanil. A study was performed on the effects of alfentanil when used during anaesthesia in infants under the age of one. After induction and relaxation alfentanil was given 20 mcg/kg i.v. initially and then the same dose repeated as needed until 10-15 min. before surgery ended. Muscle relaxation was maintained at 90-95% with vecuronium using train of four. The effects of alfentanil on airway pressure, pulse and blood pressure was measured with and without muscle relaxation. The time from end of surgery until full recovery was noted. PcC02 was measured in the recovery room. There were no clinical problems with induction or recovery. The average time until the infants opened their eyes and started moving was 1.8 min. No significant changes in pulse and blood pressure occured during surgery. Average min. ventilation was almost unchange and airway pressure showed minor increases when muscle relaxation decreased. This study shows that alfentanil is a choice to be considered in the when anaesthesia of infants when inhalational anaesthetics are considered unsuitable.
Ópíöt eru notuð í ríkum mæli við svæfingar. Á seinni árum hafa komið fram ný ópíat afbrigði, sem hafa minni hliðarverkanir en fyrri lyf. Gegnir þetta bæði um svæfinguna sjálfa og ekki síst eftir svæfingu. Minni hliðarverkanir stafa af styttri helmingunartíma og lægri dreifistuðli, sem gerir stjórnun í svæfingu auðveldari og uppvöknun öruggari og dvöl á gæsluskála þar með styttri. Eitt þessara lyfja er alfentaníl. Könnuð voru áhrif alfentaníls í svæfingu hjá 30 börnum undir eins árs aldri. Eftir innleiðslu og vöðvaslökun var gefið alfentaníl 20 ng/kg í æð sem byrjunarskammtur og síðan eftir þörfum sami skammtur þar til 10-15 mínútum fyrir áætluð aðgerðarlok. Vöðvaslökun var metin með taugaáreiti (TOF) og áhrif alfentaníls á öndunarþrýsting, púls og blóðþrýsting metin með og án vöðvaslökunar. Tíminn þar til börnin voru talin fullyöknuð var tekinn og PcC02 var mælt á gæsluskála. Ekki kom til neinna vandamála við innleiðslu né uppvöknun. Meðaltími þar til börnin opnuðu augun og fóru að hreyfa sig var 1,8 mínútúr. Engar verulegar sveiflur urðu á púls og blóðþrýstingi í aðgerð. Meðalöndunarmagn hélst nær óbreytt og öndunarvegaþrýstingur jókst óverulega er vöðvaslökun minnkaði. Rannsókn þessi sýnir að alfentaníl er valkostur við svæfingu smábarna þegar notkun iníiöndunarlyfja er talin óæskileg.
Description
Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)
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