title: Does small-dose fentanyl improve perioperative outcomes in the ambulatory setting? A randomized, double-blind, placebo-controlled study.
abstract: BACKGROUND
  Despite its widespread use, the beneficial effect of low-dose fentanyl administered at induction of anesthesia on perioperative outcomes has not been studied in the ambulatory setting. Therefore, this study was designed to test the hypothesis that administration of small-dose fentanyl vs. saline during induction reduces coughing and movements without adversely affecting recovery after day-surgery.
  
  
  METHODS
  One hundred consenting outpatients scheduled to undergo superficial surgical procedures under general anesthesia with a laryngeal mask airway (LMA) device for airway management were randomly assigned to one of two treatment groups: control (n = 50) or fentanyl (n = 50). After administration of 2 ml of the unlabelled study medication containing either fentanyl (100 μg) or saline, anesthesia was induced with lidocaine 30-50 mg and propofol 2 mg/kg IV followed by the insertion of an LMA device. General anesthesia was maintained using a propofol infusion, 75 μg/kg/min, and desflurane (2-5% end-tidal) in 100% oxygen.
  
  
  RESULTS
  Coughing was observed in six (12%) and ten (20%) in the fentanyl and control group, respectively (P = 0.41). The incidence of movements during surgery was lower in the fentanyl group (18% vs. 31%, P < 0001). There were no significant differences in early and late recovery times or pain scores between the two groups.
  
  
  CONCLUSIONS
  Administration of a small-dose of fentanyl at induction of anesthesia significantly reduced purposeful movements during day-surgery under propofol-desflurane anesthesia. No significant difference was found in coughing or recovery times.
authors.affiliation: Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA; Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy; White Mountain Institute, The Sea Ranch, CA, USA.
authors.forename: P F
authors.initials: PF
authors.lastname: White
authors.forename: O L
authors.initials: OL
authors.lastname: Elvir-Lazo
authors.forename: A S
authors.initials: AS
authors.lastname: Zaentz
authors.forename: R
authors.initials: R
authors.lastname: Kariger
authors.forename: R
authors.initials: R
authors.lastname: Yumul
authors.forename: M M
authors.initials: MM
authors.lastname: Khany
authors.forename: A
authors.initials: A
authors.lastname: Stern
authors.forename: M
authors.initials: M
authors.lastname: Vuong
authors.forename: R H
authors.initials: RH
authors.lastname: Wender
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003371:Cough / Q000139:chemically induced; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl