Effects of intravenous fentanyl around the end of surgery on emergence agitation in children: Systematic review and meta‐analysis

Kim, Namo; Park, Jin Ha; Lee, Jong Seok; Choi, Tae Yang; Kim, Min‐Soo

doi:10.1111/pan.13181

Cited by 22 publications

(21 citation statements)

References 28 publications

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“…This also explains why fentanyl can reduce the occurrence of postoperative agitation. [ 20 ] However, fentanyl may increase the risks of postoperative nausea and vomiting. Moreover, if respiratory depression caused by opioids is handled improperly, which will bring serious consequence.…”

Section: Discussionmentioning

confidence: 99%

Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy

Wang

et al. 2018

Medicine

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Dexmedetomidine is a highly selective α2 receptor agonist, this study aimed to investigate the effects of different doses of intranasal dexmedetomidine on the preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia (TIVA) for adenoidectomy with or without tonsillectomy.This is a double-blind placebo-controlled randomized trial. Pediatric were randomly divided into the D1, D2, and S groups, each group contained 30 patients. Twenty-five to 40 minutes before surgery, the D1 and D2 groups received intranasally dexmedetomidine 1 μg kg−1 or 2 μg kg−1, respectively, while the S group received saline of the same volume. A unified protocol of TIVA induction and maintenance was used for the three groups. The preoperative sedation, behavior of separation from parents, postoperative agitation, and postoperative pain of the children were evaluated.The proportions of satisfactory sedation in the D1, D2, and S groups were 63.3%, 76.7%, and 0%, respectively. There was a statistically significant difference between D1 and S groups (P = .000) and D2 versus S groups (P = .000), while there was no statistically significant difference between D1 and D2 groups (P = .399). As for scale on the behavior of separation from parents, there was a statistically significant difference between D1 and S groups (P = .009) and D2 versus S groups (P = .009), whereas there was no significant difference between D1 and D2 groups (P = 1). The incidence of postoperative agitation in the D1, D2, and S groups was 43.3%, 30.0%, and 63.3%, respectively, and there was a statistical difference between D2 and S groups (P = .010). There was a significant difference in the Pediatric Anesthesia Emergence Delirium (PAED) scale between D2 and S groups (P = .029). The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) in the D2 group was significantly lower than the S group (P = .013).The intranasal dexmedetomidine of 1 or 2 μg kg−1 25 to 40 minute before induction of anesthesia both could deliver effective preoperative sedation, reducing the children's distress of separation from parents. Moreover, intranasal dexmedetomidine of 2 μg kg−1 could deliver more effective postoperative analgesia and reduce postoperative agitation, without prolonging postoperative recovery or causing severe adverse events.

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Section: Discussionmentioning

confidence: 99%

Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy

Wang

et al. 2018

Medicine

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“…A recent systemic review supported the use of intraoperative fentanyl in the prevention of EA. 27 They showed that fentanyl use at, or 10 to 20 minutes before, the completion of surgery was effective in reducing EA. They also showed that fentanyl administered at the end of surgery increased the incidence of PONV (to 5.12-times that of the relative risk).…”

Section: Discussionmentioning

confidence: 99%

Sugammadex affects emergence agitation in children undergoing strabismus surgery

et al. 2018

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ObjectiveEmergence agitation (EA) has a multifactorial origin, and the effect of sugammadex on EA has not been established. We investigated the effect of sugammadex on EA incidence and severity.MethodsWe performed a retrospective study of children aged 1 to 13 years who underwent strabismus surgery. Patients received sugammadex or conventional neuromuscular reversal agents. The primary outcome variables were EA incidence and severity. Secondary outcome variables were postoperative fentanyl use, postoperative nausea and vomiting, time from reversal agent administration to extubation, time from the end of surgery to arrival in the post-anesthesia care unit (PACU) and time spent in the PACU. We used propensity score matching to eliminate baseline imbalances.ResultsAge, sex, use of desflurane, and intraoperative fentanyl were significant predictors of agitation severity using a multivariable analysis. Sugammadex did not significantly affect EA in logistic regression and multiple regression analyses. In the propensity-matched analysis, patients in the sugammadex group showed rapid recovery, but there was no difference in the EA incidence or severity.ConclusionSugammadex did not affect EA incidence or severity compared with conventional cholinesterase inhibitors, although it showed a favorable recovery profile in children undergoing strabismus surgery.

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“…Several studies have shown that the administration of fentanyl at the end of surgery delays awakening. 3,8,14 Considering the turnover time in the operating room, this is a significant advantage for saving time and increasing efficiency in clinical practice, especially in ambulatory surgeries with operation times of <30 minutes. 25 Fentanyl has the undesired side effect of respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis suggested that the earlier administration of fentanyl reduces the incidence of PONV and also optimally controls ED. 14 In this prospective randomized controlled trial, an extension of the aforementioned meta-analysis, we aimed to investigate the effect of the timing of fentanyl administration on PONV incidence in children undergoing tonsillectomy. We hypothesized that fentanyl administration at 10 to 15 minutes before the end of surgery would reduce the incidence of PONV compared with that at the end of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Timing of Intravenous Fentanyl Administration on the Incidence of Posttonsillectomy Nausea and Vomiting

Kim

et al. 2020

The Laryngoscope

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Objective/Hypothesis: Fentanyl is commonly administered toward the end of tonsillectomy to prevent emergence delirium and reduce postoperative pain. However, it can delay emergence from anesthesia and increase the risk of postoperative nausea and vomiting (PONV). The goal of our study was to compare the risk of PONV based on the timing of fentanyl administration at the end of tonsillectomy in children. Study Design: Prospective, double-blind, randomized controlled trial. Methods: One hundred forty patients aged 3 to 7 years undergoing tonsillectomy were divided into two groups. Fentanyl (1 μg/kg) was administered at the end of surgery in group 1 (n = 70) and at 10 to 15 minutes before the end of surgery in group 2 (n = 70). Time to regular breathing and time to emergence from anesthesia were measured from the end of surgery. PONV and pediatric anesthesia emergence delirium scale scores were assessed every 10 minutes after admission to the postanesthesia care unit. Results: Incidences of PONV (2.9% vs. 2.9%, P > .99) and emergence delirium (11.4% vs. 5.7%, P = .23) were not significantly different between the two groups. Time to regular breathing (mean difference = 2.3 minutes; 95% confidence interval [CI]: 0.9 to 3.7 minutes) and time to emergence (median difference = 6.5 minutes; 95% CI, 2.5 to 10.5 minutes) were significantly longer in group 1 than in group 2. Conclusions: Although there was no beneficial effect on PONV, recovery of regular breathing and consciousness was quicker with earlier fentanyl administration. Emergence delirium was well-controlled, similar to that with fentanyl administration at the end of surgery.

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Effects of intravenous fentanyl around the end of surgery on emergence agitation in children: Systematic review and meta‐analysis

Abstract: The current analyses indicate that fentanyl around the end of surgery reduces the incidence of emergence agitation in children undergoing general anesthesia.

Cited by 22 publications

References 28 publications

Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy

Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy

Sugammadex affects emergence agitation in children undergoing strabismus surgery

Effect of Timing of Intravenous Fentanyl Administration on the Incidence of Posttonsillectomy Nausea and Vomiting

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