title: The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Children's National Medical Center and George Washington University Medical Center, 111 Michigan Ave., Washington, DC 20010, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Finkel
authors.forename: I T
authors.initials: IT
authors.lastname: Cohen
authors.forename: R S
authors.initials: RS
authors.lastname: Hannallah
authors.forename: K M
authors.initials: KM
authors.lastname: Patel
authors.forename: M S
authors.initials: MS
authors.lastname: Kim
authors.forename: K A
authors.initials: KA
authors.lastname: Hummer
authors.forename: S S
authors.initials: SS
authors.lastname: Choi
authors.forename: M
authors.initials: M
authors.lastname: Pena
authors.forename: S B
authors.initials: SB
authors.lastname: Schreiber
authors.forename: G
authors.initials: G
authors.lastname: Zalzal
mesh_terms: D000281:Administration, Intranasal; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008297:Male; D008738:Methyl Ethers; D008876:Middle Ear Ventilation; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000209:etiology / Q000517:prevention & control; D012044:Regression Analysis; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl