l INDICATIONS AND DOSE

Spontaneous respiration: analgesia and enhancement of anaesthesia for short procedures

 BY INTRAVENOUS INJECTION

 Adult: Initially up to 500 micrograms, dose to be administered over 30 seconds; supplemental doses 250 micrograms Assisted ventilation: analgesia and enhancement of anaesthesia for short procedures

 BY INTRAVENOUS INJECTION

 Adult: Initially 30–50 micrograms/kg, supplemental doses 15 micrograms/kg Assisted ventilation: analgesia and enhancement of anaesthesia during maintenance of anaesthesia for longer procedures

 BY INTRAVENOUS INFUSION

 Adult: Initially 50–100 micrograms/kg, dose to be administered over 10 minutes or as a bolus, followed by maintenance 30–60 micrograms/kg/hour Assisted ventilation: analgesia and suppression of respiratory activity during intensive care for up to 4 days

 BY INTRAVENOUS INFUSION

Adult: Initially 2 mg/hour, adjusted according to response; usual dose 0.5–10 mg/hour, alternatively initially 5 mg in divided doses, to be administered over 10 minutes; dose used for more rapid initial control, reduce rate of administration if hypotension or bradycardia occur; additional doses of 0.5–1 mg may be given by intravenous injection during short painful procedures

DOSES AT EXTREMES OF BODY-WEIGHT

 To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight.

 CAUTIONS CAUTIONS, FURTHER INFORMATION

Repeated intraoperative doses of alfentanil should be given with care since the resulting respiratory depression can persist postoperatively and occasionally it may become apparent for the first time postoperatively when monitoring of the patient might be less intensive.

 INTERACTIONS → Appendix 1: opioids

SIDE-EFFECTS

 Common or very common Apnoea . chills . fatigue . hypertension . movement disorders . muscle rigidity . procedural complications  Uncommon Coma . hiccups . hypercapnia . pain . post procedural complications .respiratory disorders  Rare or very rare Agitation . crying . epistaxis . vascular pain  Frequency not known Cardiac arrest. cough . fever. loss of consciousness . seizure SIDE-EFFECTS, FURTHER INFORMATION

Alfentanil can cause muscle rigidity, particularly of the chest wall or jaw; this can be managed by the use of neuromuscular blocking drugs.

 BREAST FEEDING

Present in milk—withhold breastfeeding for 24 hours.

 HEPATIC IMPAIRMENT

Manufacturer advises caution. Dose adjustments Manufacturer advises dose reduction and cautious titration.

RENAL IMPAIRMENT

Avoid use or reduce dose; opioid effects increased and prolonged and increased cerebral sensitivity occurs.

 DIRECTIONS FOR ADMINISTRATION

5 mg/mL injection to be diluted before use. For continuous or intermittent intravenous infusion dilute in Glucose 5% or Sodium Chloride 0.9%.