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Oral transmucosal fentanyl citrate premedication in children
J B Streisand1, T H Stanley, B Hague
1Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City 84132.
Insights
Oral transmucosal fentanyl citrate (OTFC) effectively sedates children before surgery, with higher doses causing temporary oxygen desaturation. Postoperative nausea and vomiting were common side effects.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Preoperative anxiety and pain in children undergoing surgery can be managed with premedication.
- Oral transmucosal fentanyl citrate (OTFC) is an option for pediatric premedication.
Purpose of the Study:
- To evaluate the safety and efficacy of four doses of OTFC as a premedicant in pediatric patients.
- To assess dose-dependent effects on sedation, vital signs, and recovery.
Main Methods:
- 44 children received varying doses of OTFC (5-25 mcg/kg).
- Activity, vital signs, oxygen saturation, anesthetic induction, and recovery were monitored.
- Side effects were recorded.
Main Results:
- OTFC provided dose-dependent preoperative sedation.
- Higher OTFC doses (20-25 mcg/kg) led to transiently lower oxygen saturation.
- Anesthetic inductions were good/excellent in 80% of patients; recovery was unaffected by dose.
- Pruritus, nausea, and vomiting were common postoperative side effects.
Conclusions:
- OTFC is effective for pediatric pre-anesthetic sedation.
- Careful monitoring of oxygen saturation is recommended with higher doses.
- Common side effects include pruritus, nausea, and vomiting.
Abstract:
The authors evaluated the safety and efficacy of four doses of oral transmucosal fentanyl citrate (OTFC) as a premedicant in 44 children about to undergo elective operations. The patients received 5-10, 10-15, 15-20, or 20-25 micrograms.kg-1 of OTFC in the holding area and had activity (sedation) scores, vital signs (including systolic and diastolic arterial blood pressures, heart, and respiratory rates), and pulse oximetry determined oxygen saturation measured before and at 15-min intervals after premedication until they were taken to the operating room. Cooperation during anesthetic induction, and quality and speed of recovery room emergence were measured and side effects noted. OTFC was readily accepted and provided significant (dose dependent) reductions in preoperative activity starting after 30 min. Onset of sedation was related to dose of OTFC but time to peak effect was not. Vital signs remained unchanged preoperatively in all groups but patients receiving 20-25 micrograms.kg-1 had oxygen saturations that were significantly lower than patients in the other groups 30 min after beginning OTFC consumption. Three of the 12 patients receiving the highest dose of OTFC experienced transient oxygen saturation less than 90% which, however, was easily treated by commands to take a breath. Anesthetic inductions were rated good or excellent in 80% of the patients and recovery times were similar irrespective of the OTFC dose. OTFC caused dose-independent preoperative pruritus in 90% or more of patients and pruritus (33%-70%), nausea (30%-58%), and vomiting (50%-83%) postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)