Midazolam-alfentanil synergism for anesthetic induction in patients.

The effect of midazolam on the induction dose-response curve for alfentanil was studied in nonpremedicated ASA physical status I or II patients. The response to the verbal command was used as an end point of anesthesia. Dose-response curves for midazolam, alfentanil, and their combination were determined with a probit procedure, and compared with algebraic (fractional) analysis of drug interaction. Interaction between midazolam and alfentanil was found to be synergistic (supraadditive). The results suggest that the use of this combination is advantageous not only because it helps to achieve different anesthetic goals with specific drugs (a benzodiazepine for unconsciousness and an opioid for blockade of the responses to noxious stimulation), but also because its components are complementary for unconsciousness.