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PEDIATRIC ANESTHESIA

The Effect of Intranasal Fentanyl on the Emergence Characteristics After Sevoflurane Anesthesia in Children Undergoing Surgery for Bilateral Myringotomy Tube Placement

Julia C. Finkel, MD^*, Ira T. Cohen, MD^*, Raafat S. Hannallah, MD^*, Kantilal M. Patel, PhD, Michelle S. Kim, MD^*, Kelly A. Hummer, RN^*, Sukgi S. Choi, MD, Maria Pena, MD, Simeon B. Schreiber, MD, and George Zalzal, MD

Departments of *Anesthesiology, Pediatrics, and Otorhinolaryngology, Children’s National Medical Center and George Washington University Medical Center, Washington, DC

Address correspondence and reprint requests to Julia C. Finkel, MD, Department of Anesthesiology, Children’s National Medical Center, 111 Michigan Ave., NW, Washington DC 20010.

Children undergoing placement of bilateral myringotomy tubes (BMT) often exhibit pain-related behavior (agitation) in the postanesthesia care unit. We compared the emergence and recovery profiles of pediatric patients who received sevoflurane with or without supplementary intranasal fentanyl for BMT surgery. By using a prospective, double-blinded design, 150 children 6 mo to 5 yr of age, scheduled for routine BMT surgery, were anesthetized with sevoflurane (2%–3%) in a 60% N₂O/O₂ gas mixture. Patients were randomized to receive equal volumes of intranasal saline (Control), 1 µg/kg fentanyl or 2 µg/kg fentanyl. A blinded observer evaluated each patient using a previously described 4-point agitation scale and the Steward recovery scale. Response to parental presence was observed after a score of six (full recovery) was achieved on the Steward recovery scale. There were no significant differences among the three groups regarding age, weight, surgeon, duration of anesthesia, or ear condition. Recovery times and emergence characteristic scores were not statistically different. Agitation scores were significantly reduced in the 2-µg/kg Fentanyl group as compared with the Control group (P = 0.012). Fentanyl 2 µg/kg is recommended to reduce the incidence of agitation seen in these patients.

Implications: We examined the use of nasally administered fentanyl for the relief of agitation or discomfort after placement of bilateral myringotomy tubes in 150 children ages 6 mo to 5 yr using a prospective, double-blinded design. Fentanyl 2 µg/kg was found to reduce the incidence of agitation in these patients.

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