A comparison of alfentanil pharmacokinetics in children and adults.

The pharmacokinetics of alfentanil have been studied in eight children aged between 4 and 8 yr and five adults during general anesthesia. All patients were given 20 micrograms/kg alfentanil as an intravenous bolus injection. Plasma concentrations were measured at intervals up to 6 h by radioimmunoassay. Plasma protein binding was measured by equilibrium dialysis using tritiated alfentanil. The optimal pharmacokinetic model for alfentanil was an open two-compartment model. Total apparent volume of distribution (Vdss) was 457 +/- 160 ml/kg in adults and 163 +/- 110 ml/kg in children (P less than 0.01). When recalculated by surface area Vdss was still decreased in children (P less than 0.01). Plasma clearance (Cl) was similar in the two groups. Terminal elimination half-life was significantly shorter in children (40 +/- 9 min) than in adults (97 +/- 22 min; P less than 0.01). The shorter elimination half-life could be due to the smaller total apparent volume of distribution in children. Plasma protein binding was comparable between children and adults and could not explain the smaller volume of distribution in children. It is suggested that the smaller volume of distribution of alfentanil in children is a result of the decreased percentage of fat tissue in children.