The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement

• Published in: Anesthesia and analgesia Vol. 92; no. 5; pp. 1164 - 1168
• Main Authors: FINKEL, Julia C, COHEN, Ira T, HANNALLAH, Raafat S, PATEL, Kantilal M, KIM, Michelle S, HUMMER, Kelly A, CHOI, Sukgi S, PENA, Maria, SCHREIBER, Simeon B, ZALZAL, George
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.05.2001
• Subjects: Administration, Intranasal; Anesthesia; Anesthesia depending on type of surgery; Anesthesia Recovery Period; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation; Anesthetics, Intravenous - administration & dosage; Biological and medical sciences; Child, Preschool; Double-Blind Method; Female; Fentanyl - administration & dosage; Humans; Infant; Male; Medical sciences; Methyl Ethers; Middle Ear Ventilation; Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics; Pain, Postoperative - therapy; Prospective Studies; Psychomotor Agitation - etiology; Psychomotor Agitation - prevention & control; Regression Analysis; Sevoflurane; Human; Volatile compound; Postoperative; Agitation; Tube; Fentanyl; General anesthesia; Bilateral; Opiates; Intranasal administration; Recovery; Tympanotomy; Sevoflurane; General anesthetic; Surgery; Awakening; ENT disease; Child; Halogen Organic compounds
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-200105000-00016

Children undergoing placement of bilateral myringotomy tubes (BMT) often exhibit pain-related behavior (agitation) in the postanesthesia care unit. We compared the emergence and recovery profiles of pediatric patients who received sevoflurane with or without supplementary intranasal fentanyl for BMT surgery. By using a prospective, double-blinded design, 150 children 6 mo to 5 yr of age, scheduled for routine BMT surgery, were anesthetized with sevoflurane (2%-3%) in a 60% N(2)O/O(2) gas mixture. Patients were randomized to receive equal volumes of intranasal saline (Control), 1 microg/kg fentanyl or 2 microg/kg fentanyl. A blinded observer evaluated each patient using a previously described 4-point agitation scale and the Steward recovery scale. Response to parental presence was observed after a score of six (full recovery) was achieved on the Steward recovery scale. There were no significant differences among the three groups regarding age, weight, surgeon, duration of anesthesia, or ear condition. Recovery times and emergence characteristic scores were not statistically different. Agitation scores were significantly reduced in the 2-microg/kg Fentanyl group as compared with the Control group (P = 0.012). Fentanyl 2 microg/kg is recommended to reduce the incidence of agitation seen in these patients. We examined the use of nasally administered fentanyl for the relief of agitation or discomfort after placement of bilateral myringotomy tubes in 150 children ages 6 mo to 5 yr using a prospective, double-blinded design. Fentanyl 2 microg/kg was found to reduce the incidence of agitation in these patients.