Purchase this article with an account.
S. P. Kresovsky, J. Tao, T. Mote, W. Nunery; Fentanyl and Alfentanyl Decrease Reflex Sneezing After Propofol Sedation for Ophthalmic Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5828.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
In ophthalmic and other surgery, propofol is commonly used to sedate patients, thereby making local anesthesia infiltration more tolerable. A commonly observed side effect is sneezing or other upper respiratory reflex associated with abrupt head movement. These unexpected events can be dangerous with a needle near the globe.
81 consecutive patients undergoing oculofacial plastic surgery underwent conscious sedation just prior to local anesthesia administration. All patients received propofol. 25 patients were randomized to receive propofol only. 14 patients received midazolam and propofol. 31 patients were randomized to receive narcotic (fentanyl or alfentanyl) and propofol. 11 patients received propofol, midazolam, and narcotic. Local anesthetic was injected in the usual manner. A masked observer (surgeon or surgeon’s assistant) recorded whether the patient sneezed or had a similar upper respiratory event associated with sudden head movement.
Of the patients who received no narcotic, 17 of 39 (43.6%) sneezed. None of the patients who received narcotic had a significant upper respiratory event 0 of 42 (0%). A student’s T-test provides p<0.0001. Among the patients who did not receive narcotic, there was no statistically significant difference between the groups (propofol with or without midazolam). Of the 25 patients who received propofol only, 8 of 25 sneezed. Of the 14 patients who received both propofol and midazolam, 9 of 14 sneezed (p=0.0914). Since no patient who received narcotic sneezed, there was no difference between the groups who received narcotic with or without midazolam.
Fentanyl or alfentanyl decreased sneezing and other significant upper respiratory events after propofol sedation in this series of patients. Their concomitant use (if not contraindicated) with propofol should be considered to improve safety during local anesthetic injection in ophthalmic procedures.
This PDF is available to Subscribers Only