{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T07:09:32Z","timestamp":1771571372975,"version":"3.50.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n This randomized, double-blind, clinical comparative study aims to compare the tracheal intubation stress responses of different doses of alfentanil in anesthesia induction for ambulatory hysteroscopic surgery, as well as their impact on the quality of early postoperative recovery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This study enrolled a total of 160 patients aged 20\u201360\u202fyears scheduled for ambulatory hysteroscopic surgery. All patients underwent tracheal intubation under general anesthesia and were randomly allocated into four groups using a random number table. The low-dose alfentanil group (group AL) patients received an induction dose of 20\u202f\u03bcg\/kg alfentanil, the medium-dose alfentanil group (group AM) patients received 30\u202f\u03bcg\/kg alfentanil, the high-dose alfentanil group (group AH) received 40\u202f\u03bcg\/kg alfentanil, and the Fentanyl Group (group F) patients received an induction dose of 4\u202f\u03bcg\/kg fentanyl, with all groups additionally administered midazolam, cisatracurium, and propofol as part of the standardized induction protocol. Anesthesia maintenance was maintained with propofol and remifentanil in all groups. The primary outcome measure was the plasma norepinephrine (NE) level at 1\u202fmin after tracheal intubation (T\n 2<\/jats:sub>\n ). Secondary outcomes included plasma NE and epinephrine (E) levels at baseline (T\n 0<\/jats:sub>\n , before anesthesia induction), T\n 2<\/jats:sub>\n (excluding NE as it was the primary measure), and 5\u202fmin post-intubation (T\n 3<\/jats:sub>\n ), along with mean arterial pressure (MAP) and heart rate (HR) at T\n 0<\/jats:sub>\n , the time of the insertion of the tracheal tube (T\n 1<\/jats:sub>\n ), T\n 2<\/jats:sub>\n , T\n 3<\/jats:sub>\n , 5\u202fmin after the removal of the tracheal tube (T\n 4<\/jats:sub>\n ); additionally, extubation time, awakening time, post-anesthesia care unit (PACU) stay duration, Steward score and numerical rating scale (NRS) pain score during the PACU stay were evaluated. Safety endpoints comprised the incidence of hypertension, hypotension, tachycardia, and bradycardia from anesthesia induction to 5\u202fmin after tracheal intubation, as well as adverse events such as nausea, vomiting, and agitation during the emergence period.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The levels of plasma NE and E in group AL were significantly higher than that in group F at T\n 2<\/jats:sub>\n , the levels of plasma NE and E in group AM were significantly lower than that in group AL at T\n 2<\/jats:sub>\n \u202f~\u202fT\n 3<\/jats:sub>\n , and the levels of plasma NE and E in group AH were significantly lower than that in group AL and group F at T\n 2<\/jats:sub>\n \u202f~\u202fT\n 3<\/jats:sub>\n (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). Compared with group F, MAP and HR in group AL were significantly higher at T\n 2<\/jats:sub>\n (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). Compared with group AL, MAP and HR in group AM were significantly lower at T\n 1<\/jats:sub>\n \u202f~\u202fT\n 3<\/jats:sub>\n (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05), the incidence of hypertension and tachycardia from anesthesia induction to 5\u202fmin after tracheal intubation was significantly lower in group AM (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). Compared with group AL and group F, MAP and HR in group AH were significantly lower at T\n 1<\/jats:sub>\n \u202f~\u202fT\n 3<\/jats:sub>\n (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05), the incidence of hypotension and bradycardia was significantly higher from anesthesia induction to 5\u202fmin after tracheal intubation, and the incidence of hypertension and tachycardia was significantly lower (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05). The NRS pain scores at the time of extubation in group AL were significantly higher than in groups AM, AH, and F (\n p<\/jats:italic>\n \u202f&lt;\u202f0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In ambulatory hysteroscopic surgery, intravenous 30\u202f\u03bcg\/kg and 40\u202f\u03bcg\/kg alfentanil inhibited the stress reaction caused by tracheal intubation, alleviated hemodynamic fluctuations, and decreased the intensity of postoperative pain. However, 40\u202f\u03bcg\/kg alfentanil significantly increased the incidence of hypotension and bradycardia from anesthesia induction to 5\u202fmin after tracheal intubation. Therefore, 30\u202f\u03bcg\/kg alfentanil may be more suitable for the application of ambulatory hysteroscopic surgery.<\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n \n https:\/\/www.chictr.org.cn<\/jats:ext-link>\n , ChiCTR2300073590.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1787000","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:41:58Z","timestamp":1771569718000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of different doses of alfentanil on tracheal intubation stress responses in ambulatory hysteroscopic surgery: a randomized, double-blind, clinical comparative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xi","family":"Zha","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The Anqing Medical Center of Anhui Medical University, Affiliated Anqing Hospital of China Pharmaceutical University, Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xia","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Anqing Medical Center of Anhui Medical University, Affiliated Anqing Hospital of China Pharmaceutical University, Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinjuan","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Anqing Medical Center of Anhui Medical University, Affiliated Anqing Hospital of China Pharmaceutical University, Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siqi","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Anqing Medical Center of Anhui Medical University, Affiliated Anqing Hospital of China Pharmaceutical University, Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"4013","DOI":"10.21873\/anticanres.15199","article-title":"Severe abdominal recurrence of low-grade endometrial stromal sarcoma after hysteroscopic surgery","volume":"41","author":"Tamura","year":"2021","journal-title":"Anticancer Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1016\/j.jfma.2018.12.012","article-title":"Effectiveness and appropriateness in the application of office hysteroscopy","volume":"118","author":"Yen","year":"2019","journal-title":"J Formos Med Assoc"},{"key":"ref3","first-page":"178","article-title":"Overview of hysteroscopy","volume":"37","author":"Okohue","year":"2020","journal-title":"West Afr J 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Clin"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1097\/00006842-198312000-00002","article-title":"Epinephrine and norepinephrine responses in continuously collected human plasma to a series of stressors","volume":"45","author":"Ward","year":"1983","journal-title":"Psychosom Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1017\/s0265021505001298","article-title":"Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin?","volume":"22","author":"Kayhan","year":"2005","journal-title":"Eur J Anaesthesiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.jclinane.2016.09.026","article-title":"Dose requirements of alfentanil to eliminate autonomic responses during rapid-sequence induction with thiopental 4 mg\/kg and rocuronium 0.6 mg\/kg","volume":"35","author":"Abou-Arab","year":"2016","journal-title":"J Clin Anesth"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1186\/s12871-023-02249-z","article-title":"Effects of remimazolam combined with sufentanil on hemodynamics during anesthetic induction in elderly patients with mild hypertension undergoing orthopedic surgery of the lower limbs: a randomized controlled trial","volume":"23","author":"Xu","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/BF03004827","article-title":"A simplified scoring system for the post-operative recovery room","volume":"22","author":"Steward","year":"1975","journal-title":"Can Anaesth Soc J"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1097\/00003246-199907000-00022","article-title":"Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients","volume":"27","author":"Riker","year":"1999","journal-title":"Crit Care Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/S0304-3959(01)00349-9","article-title":"Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale","volume":"94","author":"Farrar","year":"2001","journal-title":"Pain"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1186\/s12871-024-02663-x","article-title":"Effects of different doses of alfentanil on cardiovascular response to rapid sequence intubation in elderly patients: a parallel-controlled randomized trial","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1016\/j.tjog.2019.05.019","article-title":"Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil\u2014a randomized clinical trial","volume":"58","author":"Farzi","year":"2019","journal-title":"Taiwan J Obstet Gynecol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.jacc.2020.11.002","article-title":"Cardiovascular complications of opioid use: JACC state-of-the-art review","volume":"77","author":"Krantz","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/GRF.0000000000000421","article-title":"Physiological response to opioids","volume":"62","author":"Tyan","year":"2019","journal-title":"Clin Obstet Gynecol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s00540-022-03145-5","article-title":"A comparative study on the efficacy and safety of propofol combined with different doses of alfentanil in gastroscopy: a randomized controlled trial","volume":"37","author":"Wang","year":"2023","journal-title":"J Anesth"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1111\/jphp.12578","article-title":"Synergistic analgesic effect of propofol\u2013alfentanil combination through detecting the inhibition of cAMP signal pathway","volume":"68","author":"Cao","year":"2016","journal-title":"J Pharm Pharmacol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1016\/j.bja.2018.01.041","article-title":"Adaptation of nonlinear mixed amount with zero amount response surface model for analysis of concentration-dependent synergism and safety with midazolam, alfentanil, and propofol sedation","volume":"120","author":"Liou","year":"2018","journal-title":"Br J Anaesth"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"745-52","DOI":"10.1007\/s10151-014-1188-y","article-title":"Is \u201creally conscious\u201d sedation with solely an opioid an alternative to every day used sedation regimes for colonoscopies in a teaching hospital? Midazolam\/fentanyl, propofol\/alfentanil, or alfentanil only for colonoscopy: a randomized trial","volume":"18","author":"Eberl","year":"2014","journal-title":"Tech Coloproctol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1016\/j.bjane.2012.07.007","article-title":"Sedation-analgesia in elective colonoscopy: propofol\u2013fentanyl versus propofol\u2013alfentanil","volume":"63","author":"T\u00fcrk","year":"2013","journal-title":"Braz J Anesthesiol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.vaa.2019.06.004","article-title":"Evaluation of two different radiotherapy anaesthetic protocols for dogs: a randomized clinical crossover trial","volume":"46","author":"Lehnus","year":"2019","journal-title":"Vet Anaesth Analg"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"6516","DOI":"10.1007\/s00464-021-09006-8","article-title":"Efficacy and safety of remifentanil for endoscopic ultrasound-guided tissue acquisition: a single center retrospective study","volume":"36","author":"Lin","year":"2022","journal-title":"Surg Endosc"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1016\/j.pmn.2024.04.009","article-title":"The effect of music on postoperative agitation, pain, and opioid use among patients undergoing total knee replacement","volume":"25","author":"Beatty","year":"2024","journal-title":"Pain Manag Nurs"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1177\/0267659119858037","article-title":"Sedation with alfentanil versus fentanyl in patients receiving extracorporeal membrane oxygenation: outcomes from a single-Centre retrospective study","volume":"35","author":"Barker","year":"2020","journal-title":"Perfusion"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s12871-016-0213-2","article-title":"Effects of remifentanil and remifentanil-alfentanil administration on emergence agitation after brief ophthalmic surgery in children","volume":"16","author":"Choi","year":"2016","journal-title":"BMC Anesthesiol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1093\/bja\/aes276","article-title":"Evidence-based analysis of risk factors for postoperative nausea and vomiting","volume":"109","author":"Apfel","year":"2012","journal-title":"Br J Anaesth"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"909982","DOI":"10.3389\/fmed.2022.909982","article-title":"Postoperative nausea and vomiting in female patients undergoing breast and gynecological surgery: a narrative review of risk factors and prophylaxis","volume":"9","author":"Echeverria-Villalobos","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1186\/s12871-022-01889-x","article-title":"Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study","volume":"22","author":"Zhu","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth consensus guidelines for the management of postoperative nausea and vomiting","volume":"131","author":"Gan","year":"2020","journal-title":"Anesth Analg"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1787000\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:42:00Z","timestamp":1771569720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1787000\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":45,"alternative-id":["10.3389\/fmed.2026.1787000"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1787000","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,20]]},"article-number":"1787000"}}