Oral Transmucosal Fentanyl Citrate Premedication in Children

The authors evaluated the safety and efficacy of four doses of oral transmucosal fentanyl citrate (OTFC) as a premedicant in 44 children about to undergo elective operations. The patients received 5–10, 10–15, 15–20, or 20–25 μg·kg−1 of OTFC in the holding area and had activity (sedation) scores, vital signs (including systolic and diastolic arterial blood pressures, heart, and respiratory rates), and pulse oximetry determined oxygen saturation measured before and at 15-min intervals after premedication until they were taken to the operating room. Cooperation during anesthetic induction, and quality and speed of recovery room emergence were measured and side effects noted. OTFC was readily accepted and provided significant (dose dependent) reductions in preoperative activity starting after 30 min. Onset of sedation was related to dose of OTFC but time to peak effect was not. Vital signs remained unchanged pre-operatively in all groups but patients receiving 20–25 μg·kg−1 had oxygen saturations that were significantly lower than patients in the other groups 30 min after beginning OTFC consumption. Three of the 12 patients receiving the highest dose of OTFC experienced transient oxygen saturation <90% which, however, was easily treated by commands to take a breath. Anesthetic inductions were rated good or excellent in 80% of the patients and recovery times were similar irrespective of the OTFC dose. OTFC caused dose-independent preoperative pruritus in 90% or more of patients and pruritus (33%–70%), nausea (30%–58%), and vomiting (50%–83%) postoperatively. The data suggest that 15–20 μ·kg−1 is the optimal dose range of OTFC in healthy children for optimizing onset (18.0 ± 10.3 min) and magnitude (92% calm, sedated or asleep) of preoperative sedation and minimizing preoperative respiratory side effects (lowest respiratory rate = 15.9 ± 4.1 breaths/min and lowest oxygen saturation 95.3 & 1.6%). OTFC should be compared to other premedicants using more traditional routes of delivery to determine if its benefits outweigh associated side effects.