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

Abstract

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.