Finkel et al. Anesth Analg 2001; 92: 1164-8

Reviewed by: R. Prasad, MD

Summary:

• 150 children age 6mo - 5yr for BMT surgery
• Sevo 2-3%, 60% N2O, intranasal fentanyl 1 or 2 mcg/kg, or saline. No premeds. Rectal acetominophen 40mg/kg after mask induction.
• Nasal soluction dripped slowly at least 1min after induction, half/nostril, with head turned to side (to maintain contact btwn liquid and lateral surface of nasal cavity, prevent dripping into nasopharynx).
• Blinded observer assessing agitation and recovery
• No demographic differences between groups
• Recovery and discharge times similar
• Agitation reduced in fentanyl 2mcg/kg group, but higher vomiting incidence (PACU: 12%, 0% control; Home: 4.2%, 0%)

Comments:

• Well, it's that larger study we were hoping for in a previous article summary!
• Very low PONV rate in control group ... they suggest it may be due to young age of patients
• How much overlap between the 12% vomiting in PACU and the 4.2% at home? Would have liked to see the overall 24hour incidence of PONV. Does a 12-16.2% incidence change your decision about using fentanyl?