Intravenous opioids reduce airway irritation during induction of anaesthesia with desflurane in adults†

Abstract

Desflurane is not used for the induction of anaesthesia despite its favourable pharmacokinetic characteristics because it causes airway irritation. We investigated whether pretreatment with i.v. narcotics reduced unwanted effects. One hundred and eighty adults were randomized to three groups (60 per group) to receive i.v. saline, fentanyl 1 microgram kg-1 and morphine 0.1 mg kg-1, respectively, before inhalational induction with desflurane in nitrous oxide and oxygen. Mean time to loss of response to commands was 4.0 min, without significant differences between groups. The incidence of coughing was greater (25%) in the control group than in the fentanyl (5.0%) and morphine groups (8.3%). The incidence of apnoea was 20.0% in the control group versus 13.3 and 5.0% in the fentanyl and morphine groups, respectively. Laryngospasm developed in 11.7% of controls compared with 3.3 and 1.7% in the fentanyl and morphine groups, respectively. More patients in the control group had excitatory movements (46.7%) than in the fentanyl (16.7%) and morphine (8.3%) groups. These results demonstrate that i.v. opioids reduce airway irritability significantly during inhalational induction with desflurane in adults.

General Anesthetics Sensitize the Capsaicin Receptor Transient Receptor Potential V1

“…Indeed, inhalation of desflurane [greater than 1 minimum alveolar concentration (MAC)] and isoflurane (greater than 1.5 MAC) produces airway irritation in humans, and therefore, these GAs are avoided as induction agents (Eger, 1995;Kong et al, 2000). We have shown recently that these pungent GAs excite sensory neurons by directly activating the transient receptor potential (TRP) channel TRPA1 (mustard-oil receptor) (Matta et al, 2008).…”

Desflurane Inhalation Provide Cardiovascular Stability During Intubation but Prevention of Rocuronium Injection Pain

“…The reason of stable vital signs was fentanyl. Kong and colleague [7] suggested that intravenous opioids reduce airway In conclusion, we found that early inhalation of desflurane (6%) to the patient pretreated with fentanyl attenuates adverse hemodynamic responses to nasotracheal intubation without airway irritation but has no effect on rocuronium-induced pain. …”

“…Therefore they have a general tendency to start desflurane inhalation after tracheal intubation. But several studies [6][7][8][9] have demonstrated that desflurane can be used in inhalation induction. We hypothesized that early inhalation of desflurane would be good for cardiovascular stability during intubation and also rocuronium injection pain.…”

“…In fact, upper airway irritation is one of the major drawbacks when desflurane is used as the sole induction agent. Various methods have been used to reduce adverse airway responses (coughing, breathholding, or laryngospasm), including increasing airway humidity using an artificial nose [10], applying a low [4,6] or gradual increase of inspired concentration [6], or premedication with fentanyl [7,11]. Therefore, we used an appropriate dose of fentanyl to prevent adverse airway events.…”

Evaluation of Intubating Conditions Using Sevoflurane Without Using Muscle Relaxants

“…(5) Although these side effects can be somewhat reduced by pre-treatment with morphine. (6) this is rather impractical and desflurane is rarely used for induction of anaesthesia. In contrast, sevoflurane has a less pungent, fruitier smell and permits a much smoother induction of anaesthesia with a remarkable absence of airway irritability.…”