The effect of small dose sufentanil on emergence agitation in preschool children following sevoflurane anesthesia for elective repair of unilateral inguinal hernia

OBJECTIVE: To conduct a comparative study of sufentanil and fentanyl on emergence agitation in pediatric patients.

METHODS: We conducted a prospective, randomized, and double-blind study in 80 preschool children admitted at the Pediatric Surgery, Mianyang Central Hospital, Sichuan, China between March 2011 and April 2012. They underwent sevoflurane anesthesia for elective repair of unilateral inguinal hernia. Children received a single intravenous dose of sufentanil 0.15 ug/kg or fentanyl 1.5ug/kg just before skin incision. The emergence agitation scale and the frequency of severe emergence agitation were measured. Patients who required additional fentanyl during surgery and postoperative rescue fentanyl were recorded. Recovery time and the incidence of adverse effects were assessed.

RESULTS: The mean emergence agitation scores were significantly lower in the sufentanil group compared with the fentanyl group (9.1+/-3.5 versus 12+/-3.8; 95% confidence interval [1.27+/-0.53]; p=0.001). The frequency of severe emergence agitation was 27.5% in the sufentanil group and 50% in the fentanyl group (p=0.039). Significantly fewer children in the sufentanil group received additional fentanyl during surgery compared to the fentanyl group (5% versus 20%; p=0.043) and significantly fewer children in the sufentanil group received one dose of postoperative rescue fentanyl compared to the fentanyl group (17.5% versus 42.5%; p=0.015). The incidence of vomiting was significantly higher in the fentanyl group than in the sufentanil group (p=0.023).

CONCLUSION: In preschool children undergoing repair of unilateral inguinal hernia with sevoflurane anesthesia, compared with a single dose of 1.5ug/kg fentanyl, 0.15ug/kg sufentanil before skin incision can significantly decrease the incidence of emergence agitation without delaying the recovery time.