|Two-agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery.|
|PMID: 20964769 Owner: NLM Status: MEDLINE|
|OBJECTIVES: The objective of this study was to determine whether the incidence of emergence agitation (EA) can be reduced by adding an additional, faster onset, non-IV analgesic, intranasal fentanyl or intramuscular (im) ketorolac to rectal acetaminophen.
AIM: To compare the incidence of EA after analgesia with two agents vs acetaminophen alone in pediatric patients after bilateral myringotomy procedures (BM&T).
BACKGROUND: Anesthesia for BM&T is usually performed with volatile anesthetics as a single agent without securing intravenous access. The anesthetic agent most commonly used is sevoflurane; however, EA has been reported in up to 67% of patients. Emergence agitation is distressing for parents, can impair the ability of nursing staff to adequately monitor the child, and can result in a child injuring him/herself if it is severe.
METHODS/MATERIALS: A standardized anesthetic was used with oral midazolam premedication and sevoflurane for induction, and maintenance of anesthesia. All patients received 40 mg·kg(-1) rectal acetaminophen, group 1 received acetaminophen alone, group 2 received acetaminophen and 1 mcg·kg(-1) of intranasal fentanyl, and group 3 received acetaminophen and 1 mg·kg(-1) of intramuscular ketorolac. Incidence of EA was compared using chi-square test between the acetaminophen group alone vs the two-agent analgesia groups combined. Results: There were no differences in demographic and clinical characteristics between the two groups. There were no statistically significant differences between the three groups for the incidence of EA at any time point during recovery from anesthesia nor were there any significant differences in pain scores or side effects. No significant side effects because of the administration of a second analgesic agent were reported.
CONCLUSIONS: We conclude that two-agent analgesia is not superior to acetaminophen alone for decreasing the incidence of EA after inhalation anesthesia with sevoflurane for BM&T surgery. Our overall incidence of EA was low compared to previous studies, which could potentially have decreased our ability to detect differences between groups.
|Sally Rampersad; Nathalia Jimenez; Heidi Bradford; Kristy Seidel; Anne Lynn|
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|Type: Comparative Study; Journal Article; Randomized Controlled Trial|
|Title: Paediatric anaesthesia Volume: 20 ISSN: 1460-9592 ISO Abbreviation: Paediatr Anaesth Publication Date: 2010 Nov|
|Created Date: 2010-10-22 Completed Date: 2011-02-17 Revised Date: 2014-03-24|
Medline Journal Info:
|Nlm Unique ID: 9206575 Medline TA: Paediatr Anaesth Country: France|
|Languages: eng Pagination: 1028-35 Citation Subset: IM|
|© 2010 Blackwell Publishing Ltd.|
|APA/MLA Format Download EndNote Download BibTex|
administration & dosage,
Analgesics, Non-Narcotic / administration & dosage, adverse effects, therapeutic use*
Analgesics, Opioid / administration & dosage, adverse effects, therapeutic use*
Anti-Inflammatory Agents, Non-Steroidal / administration & dosage, adverse effects, therapeutic use*
Drug Therapy, Combination
Fentanyl / administration & dosage, adverse effects, therapeutic use*
Ketorolac Tromethamine / administration & dosage, adverse effects, therapeutic use*
Middle Ear Ventilation / methods*
Pain Measurement / drug effects
Pain, Postoperative / drug therapy*
Psychomotor Agitation / prevention & control*, psychology
|T32 GM086270/GM/NIGMS NIH HHS|
|0/Analgesics, Non-Narcotic; 0/Analgesics, Opioid; 0/Anesthetics, Inhalation; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Methyl Ethers; 28523-86-6/sevoflurane; 362O9ITL9D/Acetaminophen; 4EVE5946BQ/Ketorolac Tromethamine; UF599785JZ/Fentanyl|
|Paediatr Anaesth. 2011 Sep;21(9):987
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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