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Ultra rapid onset short duration synthetic selective mu opiod agonist.
Useful for blunting the sympathetic response to laryngoscopy and to provide analgesia for short procedures.
Significant issues are cardiovascular depression and truncal rigidity.
Rapid onset is due to its pKa of 6.8 and hence predominantly unionised state at pH 7.4.

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Alfentanil's pharmacodynamics makes it ideal for use as a continuous infusion. A loading dose 10-50mcg/kg followed by infusion of 0.4-1.7mcg/kg/min with 60% nitrous oxide or a propofol infusion may be used. refl.in/fz

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For rapid sequence induction, doses of 36mcg/kg alfentanil accompanied with 4mg/kg thiopentone and 1mg/kg rocuronium has been shown to provide adequate intubating conditions within 40 seconds in 95% of ASA 1 patients. In 20% of these cases, a systolic BP of <90mmHg was noted. refl.in/g0 refl.in/fz

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In healthy patients, doses of 120mcg/kg produce unconciousness in 2 to 2.5minutes, but this may be accompanied by muscle rigidity. refl.in/fz

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Study involving 50 pediatric patients aged 3-10yrs demonstrated a ED50 of 11mcg/kg alfentanil with sevoflurane 5% to provide adequate intubating conditions within 90 seconds without muscle relaxant. 60% nitrous oxide reduces the required alfentanil dose by 25%. refl.in/g2

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Effect site equilibration time for alfentanil and remifentanil are similar (45 - 60seconds). refl.in/g1

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