The Effect of Glycopyrrolate to Support Fentanyl on Reducing Airway Irritation during Inhalation Induction with Desflurane and Nitrous Oxide in Adult Patients

Abstract

Introduction: Inhalational induction of anesthesia is occasionally used in adults. Desflurane is not used for the induction of anesthesia despite its favorable pharmacokinetic characteristics as it causes airway irritation. This study aims to identify a reduction of airway irritation with pretreatment using fentanyl and glycopyrrolate. Methods: A total of 80 adults were randomized into two groups to receive fentanyl and glycopyrrolate (FG group) or fentanyl only (FS group) prior to desflurane administration. Time between desflurane administration and loss of consciousness was recorded as well as expired desflurane concentration. Signs of airway irritation including coughing, apnea, laryngospasm, and excitatory movements at time of induction was also recorded. Unpaired t test, Fisher’s Exact test, and Chi-square test were used to analyze parametric data and all non-parametric data was analyzed using the Mann– Whitney test. Results: This study found time to loss of consciousness was 4 minutes. Incidence of airway irritation in Group FS vs FG including cough, apnea, excitatory movements, and laryngospasm was (20% vs 2.5%), (0% vs 0%), (5% vs 5%), and (7.5% vs 0%) respectively. Total airway irritation was 32.5% in FS compared to 7.5% in FG, with P value 0.0103. Conclusion: Use of fentanyl and glycopyrrolate decreases airway irritation incidence caused by desflurane in comparison to use of fentanyl alone. This opens the possibility to commonly use desflurane as inhalation induction of anesthesia as its favorable pharmacokinetics may be utilized whilst limiting the adverse effects it causes.