Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-25T12:49:40.023Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia

Published online by Cambridge University Press:  23 December 2004

S. Demirbilek ,
T. Togal ,
M. Cicek ,
U. Aslan ,
E. Sizanli  and
M. O. Ersoy
S. Demirbilek
Affiliation:
Medical School of Inonu University, Department of Anaesthesiology, Malatya, Turkey
T. Togal
Affiliation:
Medical School of Inonu University, Department of Anaesthesiology, Malatya, Turkey
M. Cicek
Affiliation:
Medical School of Inonu University, Department of Anaesthesiology, Malatya, Turkey
U. Aslan
Affiliation:
Medical School of Inonu University, Department of Anaesthesiology, Malatya, Turkey
E. Sizanli
Affiliation:
Medical School of Inonu University, Department of Anaesthesiology, Malatya, Turkey
M. O. Ersoy
Affiliation:
Medical School of Inonu University, Department of Anaesthesiology, Malatya, Turkey
Get access

Extract

Summary

Background and objective: In children, emergence agitation frequently complicates sevoflurane and desflurane anaesthesia. The effect of intravenous fentanyl 2.5 μg kg−1 was examined on the incidence of emergence agitation in children who received desflurane or sevoflurane after midazolam premedication and intravenous thiopental induction.

Methods: One hundred and twenty children (2–7 yr) undergoing adenoidectomy or tonsillectomy, or both, were studied. All children were premedicated orally with midazolam 0.5 mg kg−1. After intravenous induction with thiopental and atracurium to facilitate endotracheal intubation, patients were randomly assigned to one of four groups: Patients in Groups 1 and 3 received physiological saline solution, whereas patients in Groups 2 and 4 received intravenous fentanyl 2.5 μg kg−1 during induction. Anaesthesia was maintained with sevoflurane in Groups 1 and 2 and with desflurane in Groups 3 and 4. After discontinuation of the volatile anaesthetic, the times to tracheal extubation and response to verbal stimuli (emergence time), and emergence behaviours were recorded.

Results: The time to tracheal extubation was significantly shorter in Groups 3 (5.2 ± 1.7 min) and 4 (6.4 ± 2.1 min) than in Groups 1 (8.1 ± 2.1 min) (P = 0.0001 and 0.006, respectively) and 2 (8.8 ± 1.9 min) (P = 0.0001). The emergence time was significantly shorter in Group 3 (10.0 ± 3.9 min) than in Groups 1 (13.8 ± 4.9 min) (P = 0.017) and 2 (14.9 ± 4.1 min) (P = 0.003). The incidence rate of severe agitation was 13% in Groups 1 and 3, and 7 and 10% in Groups 2 and 4, respectively (P > 0.05).

Conclusions: After midazolam premedication and intravenous induction of anaesthesia with thiopental, administration of intravenous fentanyl 2.5 μg kg−1 did not provide any clinically significant benefit on emergence agitation in children who receive sevoflurane or desflurane anaesthesia.

Keywords

ANAESTHETICS, INHALATION, desflurane, sevofluraneCHILDREN, midazolam, premedicationCOMPLICATIONS, emergence agitation
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 7 , July 2004 , pp. 538 - 542
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology 1997; 87: 1298–1300.Google Scholar
Lapin SL, Auden SM, Goldsmith LJ, Reynolds A. Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane. Paediatr Anaesth 1999; 9: 299–304.Google Scholar
Davis PJ, Cohen IT, McGowan FX Jr, Latta K. Recovery characteristics of desflurane versus halothane for maintenance of anesthesia in pediatric ambulatory patients. Anesthesiology 1994; 80: 298–302.Google Scholar
Welborn LG, Hannallah RS, Norden JM, Ruttimann UE, Callan CM. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg 1996; 83: 917–920.Google Scholar
Moore EW, Pollard BJ, Elliott RE. Anaesthetic agents in paediatric day case surgery: do they affect outcome? Eur J Anaesthesiol 2002; 19: 9–17.Google Scholar
Sarner JB, Levine M, Davis PJ, Lerman J, Cook DR, Motoyama EK. Clinical characteristics of sevoflurane in children: a comparison with halothane. Anesthesiology 1995; 82: 38–46.Google Scholar
Lerman J, Davis PJ, Welborn LG, et al. Induction, recovery, and safety characteristics of sevoflurane in children undergoing ambulatory surgery: a comparison with halothane. Anesthesiology 1996; 84: 1332–1340.Google Scholar
Finkel JC, Cohen IT, Hannallah RS, et al. The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement. Anesth Analg 2001; 92: 1164–1168.Google Scholar
Cohen IT, Hannallah RS, Hummer KA. The incidence of emergence agitation associated with desflurane anesthesia in children is reduced by fentanyl. Anesth Analg 2001; 93: 88–91.Google Scholar
Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesth Analg 2002; 94: 1178–1181.Google Scholar
Kain ZN, Wang SM, Mayes LC, Caramico LA, Hofstadter MB. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesth Analg 1999; 88: 1042–1047.Google Scholar
Aono J, Mamiya K, Manabe M. Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anaesthesia in boys. Acta Anaesthesiol Scand 1999; 43: 542–544.Google Scholar
Kain ZN, Mayes LC, Weisman SJ, Hofstadter MB. Social adaptability, cognitive abilities, and other predictors for children's reactions to surgery. J Clin Anesth 2000; 12: 549–554.Google Scholar
Viitanen H, Annila P, Vittanen M, Tarkkila P. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg 1999; 89: 75–79.Google Scholar
Khalil SN, Vije HN, Kee SS, Farag A, Hanna E, Chuang AZ. A paediatric trial comparing midazolam/Syrpalta mixture with premixed midazolam syrup (Roche). Paediatr Anaesth 2003; 13: 205–209.Google Scholar
Veyckemans F. Excitation phenomena during sevoflurane anaesthesia in children. Curr Opin Anaesthesiol 2001; 14: 339–343.Google Scholar
Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand 2000; 44: 307–310.Google Scholar
Hannallah RS, Broadman LM, Belman AB, Abramowitz MD, Epstein BS. Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery. Anesthesiology 1987; 66: 832–834.Google Scholar
Johannesson GP, Floren M, Lindahl SG. Sevoflurane for ENT-surgery in children. A comparison with halothane. Acta Anaesthesiol Scand 1995; 39: 546–550.Google Scholar
Grundmann U, Uth M, Eichner A, Wilhelm W, Larsen R. Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane–nitrous oxide inhalation anaesthesia. Acta Anaesthesiol Scand 1998; 42: 845–850.Google Scholar
Kain ZN, Mayes LC, Wang SM, Hofstadter MB. Postoperative behavioral outcomes in children: effects of sedative premedication. Anesthesiology 1999; 90: 758–765.Google Scholar
Hallen J, Rawal N, Gupta A. Postoperative recovery following outpatient pediatric myringotomy: a comparison between sevoflurane and halothane. J Clin Anesth 2001; 13: 161–166.Google Scholar
Korpela R, Korvenoja P, Meretoja OA. Morphine-sparing effect of acetaminophen in pediatric day-case surgery. Anesthesiology 1999; 91: 442–447.Google Scholar
Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane. Paediatr Anaesth 2000; 10: 419–424.Google Scholar
Tverskoy M, Fleyshman G, Bradley EL Jr, Kissin I. Midazolam–thiopental anesthetic interaction in patients. Anesth Analg 1988; 67: 342–345.Google Scholar
Ben-Shlomo I, abd-el-Khalim H, Ezry J, Zohar S, Tverskoy M. Midazolam acts synergistically with fentanyl for induction of anaesthesia. Br J Anaesth 1990; 64: 45–47.Google Scholar
Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth 2003; 13: 63–67.Google Scholar
Runcie CJ, Mackenzie SJ, Arthur DS, Morton NS. Comparison of recovery from anaesthesia induced in children with either propofol or thiopentone. Br J Anaesth 1993; 70: 192–195.Google Scholar