Fentanyl Does Not Reduce the Incidence of Laryngospasm in Children Anesthetized with Sevoflurane

Erb, Thomas O.; Ungern‐Sternberg, Britta S. von; Keller, K.; Rosner, Gary L.; Craig, D.; Frei, Franz J.

doi:10.1097/aln.0b013e3181dcd875

Cited by 14 publications

(16 citation statements)

References 23 publications

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“…More laryngospasm was observed with sodium thiopental. Erb et al (29) demonstrated that fentanyl was not able to reduce laryngospasm incidence in the children who were anesthetized with sevoflurane.…”

Section: Discussionmentioning

confidence: 99%

Appropriate Anesthesia Regimen to Control Sevoflurane-Induced Emergence Agitation in Children: Propofol–Lidocaine and Thiopental Sodium–Lidocaine: A Randomized Controlled Trial

Rahimzadeh¹,

Faiz²,

Alebouyeh³

et al. 2014

Iran Red Crescent Med J

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Background:Emergence Agitation (EA) is a common problem in pediatric anesthesia. The current study evaluated the effect of intravenous lidocaine combined with propofol or thiopental sodium to control EA by sevoflurane in children.Objectives:The current study aimed to compare the effectiveness of two anesthesia regimen propofol–lidocaine and thiopental sodium lidocaine to control sevoflurane-induced emergence agitation in children.Patients and Methods:The study enrolled 120 children aged 12 to 36 months with retinoblastoma who underwent induction of anesthesia with sevoflurane for Eye Examination Under Anesthesia (EUA). Sampling was done at Rasoul-Akram Hospital in Tehran, Iran. The subjects were randomly assigned into four groups including: group one (thiopental sodium-lidocaine [TL]), group two (thiopental sodium-saline [TS]), group three (propofol-lidocaine [PL]), and group four (propofol-saline [PS]). Emergence agitation was assessed by using a five-point scoring scale, every 10 minutes during the first 30 minutes after admission to the recovery room.Results:EA occurred in 24 cases (20%) of children. Incidence of EA in the TS, TL, PS, and PL groups were 21 (70%), 2 (6.7%), 1 (3.3%), and 0 (0%), respectively (P < 0.001). Nausea and vomiting after anesthesia did not occur in any of the patients. After removal of the endotracheal tube, laryngospasm complication occurrence in the TS group (10 cases) was higher than the other groups and no statistically significant difference was observed (P = 0.1).Conclusions:Propofol–lidocaine anesthesia regimen was more effective to control the pediatric emergence agitation than the other combinations.

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Section: Discussionmentioning

confidence: 99%

Appropriate Anesthesia Regimen to Control Sevoflurane-Induced Emergence Agitation in Children: Propofol–Lidocaine and Thiopental Sodium–Lidocaine: A Randomized Controlled Trial

Rahimzadeh¹,

Faiz²,

Alebouyeh³

et al. 2014

Iran Red Crescent Med J

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“…Second, the results should not be extrapolated when using other anaesthetic drugs such as propofol because laryngeal and respiratory reflex responses have been demonstrated to be different when propofol is administered compared with sevoflurane [10]. Third, no control group was included in this study; however, the stability of the model over a specific time frame has been previously examined in a separate group of children anaesthetised with sevoflurane and exposed to three repeated laryngeal stimulations [19] in a similar manner to those in the present study. The laryngeal and respiratory reflex responses were remarkably constant in successive stimulations and the results were in agreement with the work of Tagaito et al [11], who found no significant differences in the incidence of laryngeal and respiratory reflex responses that could be accredited to repeat stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…Reducing the incidence of these reflexes will potentially improve the safety of anaesthesia, and administration of lidocaine in this context has been advocated for many years, even though its exact impact remains unclear [13]. Although sevoflurane is widely used in children, not least because of its ability to obtund pharyngeal and laryngeal reflexes [28], laryngospasm occurs frequently [10,19] and adjuvant medication to reduce its incidence is warranted. The results of our study suggest that the incidence of laryngospasm is decreased after the intravenous administration of lidocaine; however, the timing of administration, for example, before extubation, must be carefully planned to obtain optimum effects because it is short-acting.…”

Section: Discussionmentioning

confidence: 99%

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

et al. 2012

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SummaryWe studied the effect of intravenous lidocaine on laryngeal and respiratory reflex responses in children anaesthetised with sevoflurane. We tested the hypothesis that the incidence of laryngospasm evoked by laryngeal stimulation is temporarily diminished after the administration of lidocaine. Forty children, aged between 25 and 84 months, were anaesthetised with sevoflurane and breathed spontaneously through a laryngeal mask airway. Respiratory reflex responses were elicited by spraying distilled water onto the laryngeal mucosa at three time intervals: (i) before lidocaine was administered (baseline); (ii) at 2 min and (iii) at 10 min following the intravenous administration of a bolus of lidocaine 2 mg.kg )1 . A blinded reviewer assessed the evoked responses. The incidence of laryngospasm was reduced from 38% at baseline to 15% 2 min after lidocaine administration (p < 0.02) and 18% 10 min after lidocaine administration (p = 0.10). We conclude that intravenous lidocaine significantly reduced the incidence of laryngospasm but that the effect was short-lived. Protecting the lungs from aspiration is vitally important and is largely regulated by laryngeal and respiratory reflexes such as coughing, laryngospasm, expiration reflex, spasmodic panting and apnoea. However, exaggerated upper airway reflexes, particularly laryngospasm, have the potential to cause harm [1]. An increased incidence of laryngospasm and apnoea is observed in children compared with adults and complications resulting from hypoxaemia are more common and more severe in children [2][3][4]. Lidocaine has been demonstrated to reduce the incidence of laryngospasm in anaesthetised children [5,6]; however, its effectiveness has been questioned [7,8]. Uncertainty regarding its usefulness is partly explained by the fact that most clinical studies were underpowered to assess the relatively rare event of laryngospasm. Often more common adverse effects, such as stridor and the occurrence of hypoxaemia from whatever cause, were included in analyses assessing its incidence. Furthermore, studies examining the action of intravenous lidocaine on cough suppression during tracheal intubation revealed that the effect may only last a few minutes [9]. The potentially transient nature of this effect might make evaluation in the clinical setting difficult.

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“…The role of opioids to prevent laryngospasm remains controversial [48,64]. However, remifentanyl is increasingly used to suppress laryngeal and bronchial reflex constriction during airway manipulations [65 • ].…”

Section: Anesthetic Agentsmentioning

confidence: 99%

Diagnosis and Management of Respiratory Adverse Events in the Operating Room

Regli

Ungern‐Sternberg

2015

Curr Anesthesiol Rep

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Perioperative respiratory adverse events cause more than three-quarters of all perioperative critical incidents in pediatric anesthesia and approximately half of anesthesia-related cardiac arrests. We can define seven main clinical types of perioperative respiratory adverse events: upper airway obstruction, laryngospasm, bronchospasm, severe persistent cough, apnea, stridor, and oxygen desaturation. Depending on the definitions used for preoperative respiratory adverse events and the cohort of children examined, the incidence varies between 8 and 21 %. This review discusses the recognition and treatment of perioperative respiratory adverse events. Furthermore, it provides guidance on how to identify children who are at increased risk for developing perioperative respiratory adverse events and how to tailor the perioperative anesthetic management for the individual child in order to minimize the risk of perioperative respiratory adverse events.

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Fentanyl Does Not Reduce the Incidence of Laryngospasm in Children Anesthetized with Sevoflurane

Abstract: Two successive doses of 1.5 microg/kg fentanyl did not effectively prevent laryngospasm in children, aged 2-6 yr, anesthetized with sevoflurane.

Cited by 14 publications

References 23 publications

Appropriate Anesthesia Regimen to Control Sevoflurane-Induced Emergence Agitation in Children: Propofol–Lidocaine and Thiopental Sodium–Lidocaine: A Randomized Controlled Trial

Appropriate Anesthesia Regimen to Control Sevoflurane-Induced Emergence Agitation in Children: Propofol–Lidocaine and Thiopental Sodium–Lidocaine: A Randomized Controlled Trial

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

Diagnosis and Management of Respiratory Adverse Events in the Operating Room

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