Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children.

BACKGROUND: Propofol and fentanyl can be administered at the end of sevoflurane anaesthesia to decrease the incidence and severity of emergence agitation (EA), although it has not been determined which agent has superior efficacy. The purpose of this study was to compare the effects of propofol and fentanyl on EA. METHODS: In this prospective, randomized, double-blind study, 222 children, 18-72 months of age, undergoing sevoflurane anaesthesia were randomly assigned to one of the three groups receiving either propofol 1 mg kg(-1) (Group P), fentanyl 1 µg kg(-1) (Group F), or saline (Group S) at the end of anaesthesia. The incidence and severity of EA were evaluated with the paediatric anaesthesia emergence delirium (PAED) scale. Time to recovery and incidence of nausea/vomiting were assessed. RESULTS: The mean PAED score was 4.3 in Group P and 4.9 in Group F (P=0.682), which were lower than 9.0 in Group S (P<0.001). Nausea and vomiting were significantly more frequent in Group F than Groups P and S (adjusted P=0.003 and adjusted P<0.001). Group F had also longer stay in the post-anaesthesia care unit (PACU) than Group S (P<0.001), while Group P did not. However, the differences in PACU stays between the P and F groups were considered clinically insignificant. CONCLUSION: Small doses of propofol or fentanyl at the end of sevoflurane anaesthesia comparably reduced EA. Propofol was better than fentanyl due to a lower incidence of nausea and vomiting.

Dose-dependent attenuation by fentanyl on cough during emergence from general anesthesia.

BACKGROUND: Although fentanyl suppresses tracheal tube-induced cough during anesthetic recovery, it has not been proven if its antitussive effect is dose dependent and complication free. The purpose of this study is to evaluate the relationship between fentanyl doses and cough suppression during emergence from sevoflurane anesthesia. METHODS: Sixty patients undergoing thyroidectomy were randomly allocated to one of four groups (F0, F1, F1.5, and F2) according to the fentanyl dose (0 mcg/kg, 1 mcg/kg, 1.5 mcg/kg, or 2 mcg/kg). Fentanyl was administered immediately after sevoflurane discontinuation. Coughing was assessed throughout the periextubation period. The relationship between fentanyl dose and incidence of cough was analyzed using Cochran-Armitage trend test. Incidence of more than 30% elevation of mean arterial pressure (MAP) and heart rate (HR), awakening time, extubation time, and respiratory rate after extubation were recorded and compared using Mantel-Haenszel chi-square test and one-way analysis of variance. RESULTS: Fentanyl suppressed emergence cough in a dose-related manner (P = 0.002), and the ED(50) and ED(90) were 1.1 mcg/kg and 2.1 mcg/kg, respectively. The higher dose of fentanyl further reduced the number of patient with MAP and HR elevation (P = 0.003 and 0.005, respectively). Awakening time (8.4 ± 1.9 min) in F2 was comparable with that in F1 and F1.5. Respiratory rate (9 ± 2 bpm) and extubation time (11.9 ± 1.8 min) in F2 were only different from those in F0 (13 ± 3 bpm and 10.4 ± 1.1 min, respectively). CONCLUSIONS: Fentanyl suppressed cough in a dose-related manner during recovery from general sevoflurane anesthesia, and 2 mcg/kg may be considered as a proper dose.