JL Galinkin et al. Anesth 2000; 93:1378-83

Reviewed by: R. Prasad, MD

Conclusion:

• Pts premedicated with acetominophen 10mg/kg, midaz 0.5 mg/kg PO
• Intranasal fentanyl 2 mcg/kg immediately after induction (divided 4 doses, 2/nostril) decreased postop agitation without increases in vomiting, hypoxemia, or discharge times.
• No diff in emergence agitation sevo vs. halothane (23 vs. 10%, p=0.06)

• Interesting. Wonder if anyone here is doing it?
• Readiness for d/c from Phase I PACU prolonged; actual time not longer. 10min probably not terribly important in our PACU (most of the time, anyway).
• Need larger study to detect differences in
• incidence of important, infrequent complications from nasal fentanyl (laryngospasm, chest wall rigidity, upper airway obstruction, etc)
• sevo vs halo emergence delirium difference

• 25-50% incidence of emergence restlessness, disorientation, inconsolability after BMT (bilat myringotomy, tube placement)

• Standard anesthetic: premeds, mask induction, nasal fent after (1 mcg/kg per nostril, divided dosing). ASA I-II.
• Phase I: 26 kids. PIV placed, blood drawn to measure fentanyl levels.
• Phase II
• 265 kids. 4 groups:

• All postop observers blinded to all agents used; intraop blinded to all but gas.
• Follow-up q 5-15min for 2hrs (PACU) for vitals, agitation, pain (observational scales), phone 24hr (parents), PACU nurse satisfaction
• Power: assuming 25% incidence adverse events, needed 60/group for 80% chance to detect diff with p<0.5

• Phase I
• All had levels of fentanyl above minimum adult threshold for analgesia (pediatric threshold has not been studied).
• No adverse resp events from fentanyl.
• Phase II
• Demographics similar. No adverse events due to fentanyl.