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26146 - FENTANYL-MIDAZOLAM PREMEDICATION IMPROVES SEVOFLURANE INDUCTION

Université de Montréal, Montréal, QUÉBEC, Canada

INTRODUCTION: The course of sevoflurane inhalation induction may be altered by intravenous premedication (1). The goal of this study was to investigate the effects of fentanyl-midazolam premedication during sevoflurane induction pertaining to time to loss of eyelash reflex (LER), time and conditions of insertion of laryngeal mask airway (LMA), as well as cardio-respiratory data. Participants’ anxiety level was also evaluated.

METHODS: After approval of the Institutional Review Board and informed consent from each participant, 80 adult patients undergoing minor surgery were randomized in a double-blind fashion. Each group received either a NaCL placebo (P), or a premedication consisting of fentanyl 0,6 (µg/kg and midazolam 9 µg/kg (FM), five minutes before tidal volume sevoflurane 8% induction with 6 L/min O2. Times to LER and LMA insertion were recorded. Adverse events were also noted. Systolic blood pressure (sBP), heart rate (HR), respiratory rate (RR) and tidal volume (Vt) were recorded at one-minute intervals. End-tidal sevoflurane (EtSevo) and end-tidal CO2 (EtCO2) were mesured immediately following LMA insertion. Anxiety levels (0–10 verbal scale) were registered before and after premedication. Patients were contacted 24 hours postoperatively and were asked if they remembered the mask being applied to their face.

RESULTS: The LMA insertion was successful on all patients with one or two attempts. Time to LER (P:66±34s vs FM:47±18s, p=0.0045), and time to LMA insertion (P: 186±80s vs FM: 119±44s, p<0.0001) were shorter in FM group. After LMA insertion, EtSevo was higher (P:4.3±1.0% vs FM:3.7±0.9%, p=0.0057) and EtCO2 was lower (P:37±6 vs FM:43±7, p<0.0001) in the P group. The RR was higher in the P group (two-way ANOVA, p<0.0001) but there was no difference regarding Vt between groups. Adverse events such as movement (P:28/40 vs FM 18/40, p=0.04) and apnea (P:23/40 vs FM: 13/40, p=0.04) occurred more often in the P group, while stridor and cough occurred at similar rates. The sBP and HR during the induction period were both significantly higher in the P group (two-way ANOVA, p<0.0001) (Figure). The anxiety level after premedication was lower in FM group (P:5.1±2.7/10 vs FM:3.1±2.5/10, p=0.0009). More patients belonging to the P group remembered the mask being applied to their face compared to the FM group (P:100% vs FM:69%, p<0.0001).

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REFERENCES:

Anesth Analg 1997; 85: 1143–8[Abstract]

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