Intravenous opioids reduce airway irritation during induction of anaesthesia with desflurane in adults

• Published in: British journal of anaesthesia : BJA Vol. 85; no. 3; pp. 364 - 367
• Main Authors: Kong, C.F., Chew, S.T.H., Ip-Yam, P.C.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2000; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Aged; airway; anaesthetic techniques, induction; anaesthetics i.v., opioid, morphine; anaesthetics, volatile, desflurane; Analysis of Variance; Anesthetics, Inhalation - adverse effects; Biological and medical sciences; Cough - chemically induced; Cough - prevention & control; Desflurane; Drug toxicity and drugs side effects treatment; Female; Fentanyl - administration & dosage; Humans; Injections, Intravenous; Isoflurane - adverse effects; Isoflurane - analogs & derivatives; Laryngismus - chemically induced; Laryngismus - prevention & control; Male; Medical sciences; Middle Aged; Morphine - administration & dosage; Narcotics - administration & dosage; Pharmacology. Drug treatments; Preanesthetic Medication - methods; Toxicity: respiratory system, ent, stomatology; anaesthetics, volatile, desflurane; airway; anaesthetic techniques, induction; anaesthetics i.v., opioid, morphine; anaesthetics, volatile, desflurane; anaesthetics i.v., opioid, morphine; anaesthetic techniques, induction; airway; Volatile compound; Human; Intravenous administration; Respiratory disease; Induction; Toxicity; Fentanyl; General anesthesia; Morphine; Opiates; Cough; Inhalation; Prevention; Respiratory tract; Chemotherapy; Apnea; General anesthetic; Desflurane; Spasm; Complication; Larynx; Halogen Organic compounds; Irritation
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/85.3.364

Desflurane is not used for the induction of anaesthesia despite its favourable pharmacokinetic characteristics because it causes airway irritation. We investigated whether pretreatment with i.v. narcotics reduced unwanted effects. One hundred and eighty adults were randomized to three groups (60 per group) to receive i.v. saline, fentanyl 1 μg kg−1 and morphine 0.1 mg kg−1, respectively, before inhalational induction with desflurane in nitrous oxide and oxygen. Mean time to loss of response to commands was 4.0 min, without significant differences between groups. The incidence of coughing was greater (25%) in the control group than in the fentanyl (5.0%) and morphine groups (8.3%). The incidence of apnoea was 20.0% in the control group versus 13.3 and 5.0% in the fentanyl and morphine groups, respectively. Laryngospasm developed in 11.7% of controls compared with 3.3 and 1.7% in the fentanyl and morphine groups, respectively. More patients in the control group had excitatory movements (46.7%) than in the fentanyl (16.7%) and morphine (8.3%) groups. These results demonstrate that i.v. opioids reduce airway irritability significantly during inhalational induction with desflurane in adults.