The effect of fentanyl coadministration on sneezing during nasal local anesthetic injection for plastic surgery under propofol-based intravenous sedation: A retrospective case-controlled study.

Abstract

Injection of local anesthetic for surgical procedures on the skin of the nose under intravenous sedation can provoke sneezing, which can be hazardous to the patient, surgeon, and other staff. Yet, there is little information on factors that influence sneezing under these circumstances. The aim of our study was to investigate the influence of adding fentanyl to propofol-based sedation on the incidence of sneezing during local anesthetic injection on the nose for plastic surgery. A retrospective chart review was conducted on 32 patients who had undergone plastic surgery procedures on the nose under local anesthetic with intravenous sedation. Twenty-two patients received fentanyl in addition to propofol. Of these, only two patients sneezed (9.1 percent). In contrast, nine out of the 10 patients who did not receive fentanyl sneezed (90 percent). This included two patients who had received midazolam and propofol. These findings indicate that there was a high rate of sneezing during nasal local anesthetic injections performed under propofol-based intravenous sedation, unless the sedation was supplemented with fentanyl. We now recommend the coadministration of fentanyl during nasal local anesthetic injections under propofol-based sedation. Further studies are required to determine whether this observation is related to the depth of sedation alone, or whether the reduction in sneezing is related to the coadministration of an opioid. Further studies should also investigate potential side effects of coadministration of fentanyl or other opioids.