To evaluate nasally administered
sufentanil, 1.5-4.5 micrograms/kg, for pre-induction (i.e., pre-medication/induction) of
anesthesia in pediatric patients, the authors studied
ASA PS 1 or 2 patients scheduled for elective surgery. Eighty children, ages 6 months to 7 yr, were randomized to receive
sufentanil (1.5, 3.0, or 4.5 micrograms/kg) or placebo (
normal saline, 0.03 ml/kg) nasally over 15-20 s. Induction of
anesthesia was completed with 5%
halothane and O2 via facemask. After tracheal intubation,
anesthesia was maintained with N2O (60-70%) and
halothane, as clinically indicated. A blinded observer remained with the child from prior to
drug administration until discharge from the recovery room. Patients given
sufentanil were more likely to separate willingly from their parents and be judged as calm at or before 10 min compared to those given saline. Ventilatory compliance during induction of
anesthesia decreased markedly in 25% of subjects given
sufentanil, 4.5 micrograms/kg. Subjects given
sufentanil moved or coughed less during tracheal intubation and required less
halothane compared to those given placebo. During recovery, patients given
sufentanil cried less and fewer needed
analgesics; recovery times were similar for all groups. However, patients given
sufentanil, 4.5 micrograms/kg, had a higher incidence of
vomiting in the recovery room and during the first postoperative day. The authors conclude that nasally administered
sufentanil, 1.5 or 3.0 micrograms/kg, facilitates separation of children from parents, has minimal side effects, may improve intubating conditions, and can provide postoperative
analgesia.