• airway irritation;
  • anesthesia;
  • anesthetics;
  • complications;
  • desflurane;
  • fentanyl;
  • inhalation;
  • narcotics;
  • pediatric

Background:  Airway irritation is a major drawback of desflurane anesthesia. This study was designed to evaluate the effect of intravenous fentanyl given before thiopental induction on airway irritation caused by a stepwise increase in desflurane in children.

Methods:  Eighty children (2–8 years) were enrolled in a randomized, double-blind study. Forty received saline and 40 received 2 μg/kg of fentanyl intravenously; this was followed by thiopental sodium 5 mg/kg in both groups. Patients were assistant-ventilated with desflurane 1%, which was then increased by 1% every six breaths up to 10%. During this period, cough, secretion, excitation and apnea were graded and the desflurane concentration at which airway irritation symptoms first occurred was recorded. The results were analyzed using Pearson’s chi-squared test.

Results:  The incidence of typical airway irritation events was lower with fentanyl than with saline (cough, 2.5% vs. 42.5%; secretion, 27.5% vs. 82.5%; excitation, 10% vs. 82.5%; apnea, 20% vs. 65%; P < 0.05). The mean expired desflurane concentration at which the first airway irritation symptom occurred was greater with fentanyl than with saline (7.3% vs. 5.5%, P < 0.05).

Conclusions:  Intravenous fentanyl in children reduces airway complications caused by desflurane.