Alfentanil suppresses coughing and agitation during emergence from isoflurane anesthesia

Abstract Study Objective: To evaluate the effectiveness of alfentanil in suppressing coughing and agitation during emergence from isoflurane anesthesia. Design: Randomized, double-blind, placebo-controlled study. Setting: Operating rooms at a university medical center. Patients: 34 healthy ASA physical status I and II adult patients scheduled to undergo oral surgical procedures. Interventions: During emergence from anesthesia, patients received either alfentanil 15 μg/kg (in 10 ml) or saline (10 ml) when the end-tidal isoflurane concentration reached 0.3%. Measurements and Main Results: Hemodynamic variables were measured at one-minute intervals following administration of the study medication. A blinded observer recorded the time for patients to spontaneously open their eyes and to follow commands after discontinuing the isoflurane. The occurrence of coughing and agitation prior to extubation was noted. Patients in the alfentanil treatment group exhibited a reduced incidence of coughing prior to extubation (6% vs. 83%, respectively) and a longer 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-treated patients, resulting in similar extubation times for both groups. Alfentanil administration was also associated with lower heart rate, systolic diastolic, and mean arterial pressure values during the emergence period. Conclusion: Alfentanil decreased coughing, agitation, and cardiovascular stimulation during emergence from isoflurane anesthesia without prolonging the time to extubation.