title: Comparison between intraoperative fentanyl and tramadol to improve quality of emergence.
abstract: BACKGROUND
  Cough causes poor quality of emergence from anesthesia and risks of several complications. We compared fentanyl and an antitussive action of tramadol on the quality of emergence and postoperative outcome.
  
  
  METHODS
  A total of 110 adults (18 to 83 y) of American Society of Anesthesiologists physical status I-III undergoing elective lumbar microdiscectomy with intubated total intravenous anesthesia were randomly divided into 2 groups of 55 each. The patients assigned to the fentanyl group received a dose of 1 μg/kg of fentanyl, whereas those assigned to the tramadol group received 1 mg/kg of tramadol, at the beginning of skin closure. We recorded the incidence of cough, quality of extubation at fixed times, maximal heart rates, maximal blood pressure during emergence, postoperative pain scores, and consumption of fentanyl. In addition, postoperative sore throat (POST), hoarseness, postoperative nausea and vomiting, and other anesthetic and surgical-related complications were recorded.
  
  
  RESULTS
  Tramadol reduced cough incidence, improved extubation quality, and provided more stable hemodynamics during emergence. There was no significant difference in postoperative pain, fentanyl consumption, incidence and severity of POST, hoarseness, and postoperative nausea and vomiting between groups. Moreover, we found that the incidence of POST did not correlate with cough incidence.
  
  
  CONCLUSIONS
  A dose of 1 mg/kg of tramadol administered intravenously 30 minutes before the expected extubation, compared with 1 μg/kg of fentanyl, decreased cough incidence, improved emergence quality, and provided stable hemodynamics. However, there was no significant difference between tramadol and fentanyl in pain scores and fentanyl consumption postoperatively.
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Bo-Feng
authors.initials: BF
authors.lastname: Lin
authors.forename: Da-Tong
authors.initials: DT
authors.lastname: Ju
authors.forename: Chen-Hwan
authors.initials: CH
authors.lastname: Cherng
authors.forename: Nan-Kai
authors.initials: NK
authors.lastname: Hung
authors.forename: Chun-Chang
authors.initials: CC
authors.lastname: Yeh
authors.forename: Shun-Ming
authors.initials: SM
authors.lastname: Chan
authors.forename: Ching-Tang
authors.initials: CT
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000494:pharmacology* / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D001794:Blood Pressure / Q000187:drug effects; D003371:Cough / Q000517:prevention & control; D017586:Diskectomy; D005260:Female; D005283:Fentanyl / Q000494:pharmacology* / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000494:pharmacology* / Q000627:therapeutic use; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D012720:Severity of Illness Index; D014147:Tramadol / Q000494:pharmacology* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009294:Narcotics; D014147:Tramadol; D005283:Fentanyl