The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement

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