www.uclahealth.org
Wait…what?
Now this is also a tragedy. Since Alfentanil is gone, I said to my self - I guess it’s time to get reacquainted with my old pal sufenta.
Too slow onset, too long effect. Which is great for long haul surgeries and sick ones, not so great for short and sweet. Great as a single drug for shoulder reductions,too (I may be mistaken, but these might be handled mostly in the ED in the US?).
Alfentanil was cheaper than fentanyl I think.
This -
everybody already has fentanyl tho, so its adding something else.. for kind of no reason.
It is nice, but I've become less of a fan of infusions of potent short acting synthetic opioids (basically the remi su and al -fentanils), since I think opioid induced hyperalgesia is a thing. About the only time I do it now is to balance the reduced volatile levels in cases requiring neuromonitoring - and the current group of monitoring people I work with don't really seem to care about volatile anesthetics so mostly I just run a MAC of gas and no opioid infusion.
Respectfully....i'm not sure i agree with this. At least in my practice fentanyl does a great job for short and sweet cases.
Alfenta nerd drug?
Used it all the time for our ECT gig. Not sure why there was only 1 company manufacturing al, but it sounds like there were big problems with Akorn beyond keeping up a steady demand for al.If you friggin arse-holes would have used it more - they would have not gone out of business, and I could still be using my wonder drug.
Alfentanil (1976-2023)
We haven’t had alfenta on formulary in 25 years. Ditto for remi until we got a new neurosurgeon who demanded it for “quick wake-up’s”, with no clue that our wakeups are always quick.
.
It was a solution looking for a problem.Alfentanil was popular in our department during my training years. It was the pet drug of two of the faculty members. Alfentil/propofol worked reasonably well for intubation, better than propofol+mivacurium
Haven’t seen it since residency and I can’t say I miss it.
Alf reduces seizure threshold and also reduces propofol/hypnotic requirements = better seizures.
alyssaburgart.substack.com
Man, I ain't seen pentobarbital a single day in my life.
I’m mostly kidding. I’ve used it for retrobulbar blocks and it’s fine. The last time I saw it used (not my patient) a CRNA pushed in with sux to induce a patient that needed to be intubated and they went into asystole.
is alfentanil more likely to induce severe bradycardia compared to say an equipotent dose of fentanyl?
I think the combo has been known to do it, probably could do it with any narcotic combined with sux in patient with ph 6.9 (guessing) from poor ventilation
Surprisingly, patients develop a “tolerance” to stimulation that induce seizures (just like a a drug tolerance can be built up). So the name of the game becomes reducing the dosage of anything that raises the seizure threshold and adding stimulants (flumaz, caffeine, changing to bitemporal) to help keep the stimulus above the seizure threshold despite the built up tolerance. These patients can receive ECT 3 times a week for a month- so you can imagine tolerance can build up fast. Al allowed for a good reduction in your induction agent dose which can make all the difference in obtaining an effective seizure in the frequent flyer patient.
