• C F Kong, S T Chew, and P C Ip-Yam.
• Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore.
• Br J Anaesth. 2000 Sep 1;85(3):364-7.

AbstractDesflurane is not used for the induction of anaesthesia despite its favourable pharmacokinetic characteristics because it causes airway irritation. We investigated whether pretreatment with i.v. narcotics reduced unwanted effects. One hundred and eighty adults were randomized to three groups (60 per group) to receive i.v. saline, fentanyl 1 microgram kg-1 and morphine 0.1 mg kg-1, respectively, before inhalational induction with desflurane in nitrous oxide and oxygen. Mean time to loss of response to commands was 4.0 min, without significant differences between groups. The incidence of coughing was greater (25%) in the control group than in the fentanyl (5.0%) and morphine groups (8.3%). The incidence of apnoea was 20.0% in the control group versus 13.3 and 5.0% in the fentanyl and morphine groups, respectively. Laryngospasm developed in 11.7% of controls compared with 3.3 and 1.7% in the fentanyl and morphine groups, respectively. More patients in the control group had excitatory movements (46.7%) than in the fentanyl (16.7%) and morphine (8.3%) groups. These results demonstrate that i.v. opioids reduce airway irritability significantly during inhalational induction with desflurane in adults.

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