Post‐induction alfentanil reduces sevoflurane‐associated emergence agitation in children undergoing an adenotonsillectomy

Background: Emergence agitation is a common problem in paediatric anaesthesia, especially after volatile induction and maintenance anaesthesia (VIMA) with sevoflurane. The purpose of this study was to investigate the effect of alfentanil to prevent emergence agitation without delayed recovery after VIMA with sevoflurane in children undergoing an adenotonsillectomy. Methods: One hundred and five children, aged 3–10 years, were randomly allocated to receive normal saline (control group), alfentanil 10 μg/kg (A10) or 20 μg/kg (A20) 1 min after loss of the eyelash reflex. Anaesthesia was induced and maintained with sevoflurane. Time to tracheal extubation, recovery time, Paediatric Anaesthesia Emergence Delirium (PAED) scale and emergence behaviour were assessed. Results: The incidence of severe agitation was significantly lower in the A10 and A20 groups compared with those in the control group (11/32 and 12/34 vs. 24/34, respectively) ( P =0.007, 0.006, respectively). PAED scales were significantly different between the three groups ( P =0.008), and lower in the A10 and A20 groups than that in the control group ( P =0.044, 0.013, respectively). However, the incidence of severe agitation and PAED scale was not different between the A10 and the A20 groups. Time to tracheal extubation and recovery time were similar in all three groups. Conclusion: The administration of alfentanil 10 μg/kg after induction of anaesthesia for children undergoing an adenotonsillectomy under VIMA reduced the incidence of emergence agitation without delaying the recovery time or causing significant hypotension.