Effects of fentanyl administration before induction of anesthesia and placement of the Laryngeal Mask Airway: A randomized, placebo-controlled trial

Research output: Contribution to journalArticle

Abstract

Study Objective To assess the effects of fentanyl administered before induction of anesthesia on movement and airway responses during desflurane anesthesia via the Laryngeal Mask Airway (LMA). Design Randomized, double-blinded, controlled trial. Study Setting Tertiary-care academic center. Patients 100 adult, ASA physical status 1, 2, and 3 patients undergoing ambulatory surgery. Interventions Patients were administered fentanyl 1 μg/kg (n=51) or saline (n=49) 3 to 5 minutes before induction with propofol 2-2.5 mg/kg intravenously (IV), followed by LMA placement. Anesthesia was maintained with desflurane titrated to a bispectral index (BIS) of 50-60 and 50% nitrous oxide in oxygen, and fentanyl 25 μg boluses were titrated to respiratory rate. Measurements Apnea occurrence and duration of manual ventilation, as well as frequency and severity of movement, coughing, breath holding, and laryngospasm were recorded. Main Results Two patients in each group were excluded from analysis. The fentanyl pretreatment group had a higher frequency of apnea (94% vs 64%; P= 0.0003) and longer duration of manual ventilation (3 [interquartile range (IQR), 1.5-5] min vs 1 [0-1.5] min; P< 0.0001) at induction. In contrast, the fentanyl pretreatment group had a lower frequency of movements (16% vs 51%;P= 0.0001). The rates of intraoperative breath holding (6.1% vs 8.5%) and laryngospasm (2% vs 4.3%) in the two groups were similar. All subjects experiencing laryngospasm were smokers. Adjusting for smoking status did not affect the differences noted in apnea, duration of manual ventilation, or movement between groups; however, coughing occurrence was statistically higher in the placebo group (P= 0.043). Conclusions Preinduction fentanyl increased the frequency of apnea at induction and duration of manual ventilation, but reduced the frequency of movements. In addition, it reduced intraoperative coughing in smokers.

Original languageEnglish (US)
Pages (from-to)136-142
Number of pages7
JournalJournal of Clinical Anesthesia
Volume26
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Laryngeal Masks
Fentanyl
Anesthesia
Randomized Controlled Trials
Placebos
Laryngismus
Apnea
Breath Holding
Nitrous Oxide
Propofol
Respiratory Rate
Ambulatory Surgical Procedures
Tertiary Care Centers
Smoking
Oxygen

Keywords

  • Airway responses
  • Desflurane
  • Fentanyl pretreatment
  • Laryngeal Mask Airway

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

@article{2c8f9f5f531641f1b0c3d696021adbfa,
title = "Effects of fentanyl administration before induction of anesthesia and placement of the Laryngeal Mask Airway: A randomized, placebo-controlled trial",
abstract = "Study Objective To assess the effects of fentanyl administered before induction of anesthesia on movement and airway responses during desflurane anesthesia via the Laryngeal Mask Airway (LMA). Design Randomized, double-blinded, controlled trial. Study Setting Tertiary-care academic center. Patients 100 adult, ASA physical status 1, 2, and 3 patients undergoing ambulatory surgery. Interventions Patients were administered fentanyl 1 μg/kg (n=51) or saline (n=49) 3 to 5 minutes before induction with propofol 2-2.5 mg/kg intravenously (IV), followed by LMA placement. Anesthesia was maintained with desflurane titrated to a bispectral index (BIS) of 50-60 and 50{\%} nitrous oxide in oxygen, and fentanyl 25 μg boluses were titrated to respiratory rate. Measurements Apnea occurrence and duration of manual ventilation, as well as frequency and severity of movement, coughing, breath holding, and laryngospasm were recorded. Main Results Two patients in each group were excluded from analysis. The fentanyl pretreatment group had a higher frequency of apnea (94{\%} vs 64{\%}; P= 0.0003) and longer duration of manual ventilation (3 [interquartile range (IQR), 1.5-5] min vs 1 [0-1.5] min; P< 0.0001) at induction. In contrast, the fentanyl pretreatment group had a lower frequency of movements (16{\%} vs 51{\%};P= 0.0001). The rates of intraoperative breath holding (6.1{\%} vs 8.5{\%}) and laryngospasm (2{\%} vs 4.3{\%}) in the two groups were similar. All subjects experiencing laryngospasm were smokers. Adjusting for smoking status did not affect the differences noted in apnea, duration of manual ventilation, or movement between groups; however, coughing occurrence was statistically higher in the placebo group (P= 0.043). Conclusions Preinduction fentanyl increased the frequency of apnea at induction and duration of manual ventilation, but reduced the frequency of movements. In addition, it reduced intraoperative coughing in smokers.",
keywords = "Airway responses, Desflurane, Fentanyl pretreatment, Laryngeal Mask Airway",
author = "Joshi, {Girish P.} and Amin Kamali and Jin Meng and Eric Rosero and Irina Gasanova",
year = "2014",
doi = "10.1016/j.jclinane.2013.09.008",
language = "English (US)",
volume = "26",
pages = "136--142",
journal = "Journal of Clinical Anesthesia",
issn = "0952-8180",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Effects of fentanyl administration before induction of anesthesia and placement of the Laryngeal Mask Airway

T2 - A randomized, placebo-controlled trial

AU - Joshi, Girish P.

AU - Kamali, Amin

AU - Meng, Jin

AU - Rosero, Eric

AU - Gasanova, Irina

PY - 2014

Y1 - 2014

N2 - Study Objective To assess the effects of fentanyl administered before induction of anesthesia on movement and airway responses during desflurane anesthesia via the Laryngeal Mask Airway (LMA). Design Randomized, double-blinded, controlled trial. Study Setting Tertiary-care academic center. Patients 100 adult, ASA physical status 1, 2, and 3 patients undergoing ambulatory surgery. Interventions Patients were administered fentanyl 1 μg/kg (n=51) or saline (n=49) 3 to 5 minutes before induction with propofol 2-2.5 mg/kg intravenously (IV), followed by LMA placement. Anesthesia was maintained with desflurane titrated to a bispectral index (BIS) of 50-60 and 50% nitrous oxide in oxygen, and fentanyl 25 μg boluses were titrated to respiratory rate. Measurements Apnea occurrence and duration of manual ventilation, as well as frequency and severity of movement, coughing, breath holding, and laryngospasm were recorded. Main Results Two patients in each group were excluded from analysis. The fentanyl pretreatment group had a higher frequency of apnea (94% vs 64%; P= 0.0003) and longer duration of manual ventilation (3 [interquartile range (IQR), 1.5-5] min vs 1 [0-1.5] min; P< 0.0001) at induction. In contrast, the fentanyl pretreatment group had a lower frequency of movements (16% vs 51%;P= 0.0001). The rates of intraoperative breath holding (6.1% vs 8.5%) and laryngospasm (2% vs 4.3%) in the two groups were similar. All subjects experiencing laryngospasm were smokers. Adjusting for smoking status did not affect the differences noted in apnea, duration of manual ventilation, or movement between groups; however, coughing occurrence was statistically higher in the placebo group (P= 0.043). Conclusions Preinduction fentanyl increased the frequency of apnea at induction and duration of manual ventilation, but reduced the frequency of movements. In addition, it reduced intraoperative coughing in smokers.

AB - Study Objective To assess the effects of fentanyl administered before induction of anesthesia on movement and airway responses during desflurane anesthesia via the Laryngeal Mask Airway (LMA). Design Randomized, double-blinded, controlled trial. Study Setting Tertiary-care academic center. Patients 100 adult, ASA physical status 1, 2, and 3 patients undergoing ambulatory surgery. Interventions Patients were administered fentanyl 1 μg/kg (n=51) or saline (n=49) 3 to 5 minutes before induction with propofol 2-2.5 mg/kg intravenously (IV), followed by LMA placement. Anesthesia was maintained with desflurane titrated to a bispectral index (BIS) of 50-60 and 50% nitrous oxide in oxygen, and fentanyl 25 μg boluses were titrated to respiratory rate. Measurements Apnea occurrence and duration of manual ventilation, as well as frequency and severity of movement, coughing, breath holding, and laryngospasm were recorded. Main Results Two patients in each group were excluded from analysis. The fentanyl pretreatment group had a higher frequency of apnea (94% vs 64%; P= 0.0003) and longer duration of manual ventilation (3 [interquartile range (IQR), 1.5-5] min vs 1 [0-1.5] min; P< 0.0001) at induction. In contrast, the fentanyl pretreatment group had a lower frequency of movements (16% vs 51%;P= 0.0001). The rates of intraoperative breath holding (6.1% vs 8.5%) and laryngospasm (2% vs 4.3%) in the two groups were similar. All subjects experiencing laryngospasm were smokers. Adjusting for smoking status did not affect the differences noted in apnea, duration of manual ventilation, or movement between groups; however, coughing occurrence was statistically higher in the placebo group (P= 0.043). Conclusions Preinduction fentanyl increased the frequency of apnea at induction and duration of manual ventilation, but reduced the frequency of movements. In addition, it reduced intraoperative coughing in smokers.

KW - Airway responses

KW - Desflurane

KW - Fentanyl pretreatment

KW - Laryngeal Mask Airway

UR - http://www.scopus.com/inward/record.url?scp=84899074527&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899074527&partnerID=8YFLogxK

U2 - 10.1016/j.jclinane.2013.09.008

DO - 10.1016/j.jclinane.2013.09.008

M3 - Article

C2 - 24629823

AN - SCOPUS:84899074527

VL - 26

SP - 136

EP - 142

JO - Journal of Clinical Anesthesia

JF - Journal of Clinical Anesthesia

SN - 0952-8180

IS - 2

ER -