Alfentanil decreases the excitatory phenomena of sodium methohexital

Study Objective: To evaluate the effects of alfentanil or lidocaine on the excitatory phenomena (myoclonus, cough, hiccough) caused by methohexital anesthesia and on the hemodynamic changes induced by retrobulbar block. Design: Prospective, randomized, placebo-controlled, double-blind study. Setting: University-affiliated, tertiary-care hospital. Patients: 60 ASA physical status II and III patients who were admitted for elective cataract extractions and intraocular lens implantations. Interventions: Patients were randomly assigned to one of three groups. After adequate preoxygenation in the holding area, Group I received alfentanil 5 μg/kg intravenously (IV), Group 2 received lidocaine 1 mg/kg IV, and Group 3 received the placebo (saline) IV. Immediately after the bolus injection of the study solution, sodium methohexital 1.5 mg/kg was injected IV over 30 seconds. As soon as the eyelid reflex was lost, the retrobulbar block was placed over 5 seconds. Measurements and Main Results: Occurrences of excitatory phenomena were recorded by an independent observer who was blinded as to treatment allocation. Other side effects such as oculocardiac reflex, nausea, vomiting, itching, or chest wall rigidity were recorded. Vital signs were recorded at baseline and 1, 3, and 5 minutes after placement of the block. In the alfentanil group, the incidence of myoclonus or cough was significantly less than in the lidocaine or placebo groups. Alfentanil also decreased systolic and diastolic blood pressure significantly at 1, 3, and 5 minutes after retrobulbar block. Changes in heart rate were not significantly different from baseline. Conclusion: A small dose of alfentanil (5 μg/kg IV) decreases myoclonus and cough induced by sodium methohexital anesthesia IV, resulting in improved quality of induction of anesthesia. Alfentanil also attenuates the cardiovascular responses caused by placement of a retrobulbar block.