Sufentanil, fentanyl, and alfentanil in head trauma patients:: A study on cerebral hemodynamics

Objectives: To determine the effects of bolus injection and infusion of sufentanil, alfentanil, and fentanyl on cerebral hemodynamics and electroencephalogram activity in patients with increased intracranial pressure (ICP) after severe head trauma. Design: Randomized, unblended, crossover study, Setting: Intensive care unit and trauma center in a university hospital. Patients: Six patients with head trauma and ICP monitoring, sedated at the time of the study with propofol infusion and full neuromuscular blockade, Interventions: Following a randomized order, in an unblended and crossover fashion, the level of sedation was deepened with a g-min injection of either sufentanil (1 mu g/kg), alfentanil (100 mu g/kg), or fentanyl (10 mu g/kg) followed by an infusion of 0.005, 0.7, and 0.075 mu g/kg/min, respectively, for 1 hr, The three opioids were given to each patient at 24-hr intervals. Measurements and Main Results: Mean arterial pressure (MAP), ICP, cerebral perfusion pressure (CPP), and jugular vein bulb oxygen saturation (Svjo(2)) were continuously measured and recorded at 1-min intervals throughout the 60-min study period. Sufentanil, fentanyl, and alfentanil infusions were associated with a significant but transient increase in ICP (9 +/- 2 mm Hg [SD], 8 +/- 2 mm Hg, and 5.5 +/- 1 mm Hg, respectively; p<.05). The increase in ICP peaked at 5, 6, and 3 mins, respectively, then gradually decreased and returned to baseline values after 15 mins, This result was accompanied by a significant decrease in MAP (21 +/- 2 mm Hg, 24 +/- 2 mm Hg, and 26 +/- 2 mm Hg, respectively; p<.05) and, thus, in CPP (30 +/- 3 mm Hg, 31 +/- 3 mm Hg, and 34 +/- 3 mm Hg, respectively; p<.05), After 5 mins, MAP and CPP gradually increased, although they remained significantly decreased throughout the study period. No changes in lactate-oxygen index, used as an ischemia index, were observed. Changes in electroencephalogram tracings were characterized by a switch from a fast to a decreased activity, together with an improvement in the background activity. Conclusion: The results of the present study show that alfentanil, sufentanil, and fentanyl produce similar transient increases in ICP when administered by bolus injection in patients with increased ICP. No evidence of cerebral ischemia was observed in the study patients.