Trade-offs in airway stability vs. hemodynamic safety: a retrospective study of alfentanil-sevoflurane-propofol anesthesia for tracheal intubation.

BACKGROUND

Tracheal intubation surgeries are generally challenging procedures compared to other surgeries. Alfentanil is generally used to treat postoperative pain, but it has respiratory depression. The study examined four anesthetic techniques propofol/alfentanil, sevoflurane/alfentanil, propofol/sevoflurane, and propofol/sevoflurane/alfentanil to see if there is an association with a variety of anesthetic parameters for tracheal intubation surgery while maintaining spontaneous breathing.

METHODS

In retrospective analyses, patients received intravenous propofol and bolus alfentanil (PA cohort, n = 105) or exposed to sevoflurane gas and received bolus alfentanil (SA cohort, n = 107) or received intravenous propofol and exposed to sevoflurane gas (PS cohort, n = 109) or received intravenous propofol and bolus alfentanil and exposed to sevoflurane gas (SD cohort, n = 02).

RESULTS

Patients of the SD cohort achieved the best airway conditions, characterized by faster loss of eyelash reflex and quicker laryngeal mask insertion. However, patients of the SD cohort also exhibited worse hemodynamic stability, shorter operative times, higher postoperative complications, and prolonged hospital stays. Those results were followed for the patients of the PA, PS, and SA cohorts (p < 0.05 for all comparisons). Patients of the SD cohort required fewer numbers of postoperative administrations of a bolus dose of alfentanil than those of patients of the PS, PA, and SA cohorts (p < 0.05 for all comparisons).

CONCLUSIONS

While the propofol-sevoflurane-alfentanil combination improved airway conditions, it caused universal hypotension and frequent bradycardia. Fixed-dose alfentanil (10 µg/kg) without titration may be unsafe in spontaneous breathing protocols due to respiratory depression.