The effects of low-dose fentanyl on emergence agitation and quality of life in patients with moderate developmental disabilities

Abstract

Study Objective To analyze whether emergence agitation could be reduced by using a low dosage of fentanyl without causing an increase in postoperative adverse effects and/or affecting the patient's quality of life after discharge. Design Randomized, controlled crossover trial. Setting University medical center. Patients One hundred ten ASA physical status I and II ambulatory patients with moderate developmental disabilities who received anesthesia for dental care. Interventions During their first visit, patients were randomly treated either with a placebo or a 1- to 1.5- μg/kg dose of fentanyl before inserting a reinforced laryngeal mask airway and treated with the remaining method during their second visit 6 to 12 months later. Measurements Measured variables included anesthetic and emergence period, the occurrence of emergence agitation, and postanesthetic adverse effects such as nausea and vomiting. After discharge, the patient's quality of life was evaluated based on disturbances in daily activity, eating habit, and sleeping behavior. Results were analyzed by Student t test and McNemar test ( P < 0.05). Main Results Between the two treatments, there was a significant difference in the frequency of emergence agitation ( P = 0.04) but no postoperative adverse effects such as postoperative nausea and vomiting. We also found no significant disturbances in the patient's quality of life according to daily activity, eating habits, or sleeping behavior. Conclusion Emergence agitation may be reduced by using 1 to 1.5 μg/kg of fentanyl during induction while maintaining anesthesia by sevoflurane in patients with moderate developmental disabilities undergoing dental care, without causing an increase in postoperative adverse effects and affecting the patient's life quality after discharge.