Small doses of propofol or fentanyl at the end of sevoflurane anaesthesia comparably reduced EA. Propofol was better than fentanyl due to a lower incidence of nausea and vomiting.

Fentanyl suppressed cough in a dose-related manner during recovery from general sevoflurane anesthesia, and 2 mcg/kg may be considered as a proper dose.

Emergence agitation after sevoflurane anaesthesia in children Editor-We read with interest the article by Lee and colleagues comparing propofol and fentanyl for prevention of emergence agitation after sevoflurane anaesthesia in children. 1 We thank the authors for their work in this very common and often very distressing scenario. We would like to raise a few important questions regarding this study. Pain is one of the important causes for emergence agitation particularly in children, 2 and although the authors excluded the children in whom caudal analgesia had not worked, we think assessment of pain by appropriate scales would have been very helpful in addressing this confounding factor. Also considering the authors have used lidocaine for caudal analgesia and the patients had at least 60 min duration of anaesthesia and a further 40 min in Post Anaesthesia Care Unit (PACU), we consider assessment of pain in PACU would have been invaluable data in this study. Propofol was used as the rescue agent for severe agitation in PACU. Considering that propofol was one of the study drugs, we think that it introduces bias into the study. The starvation times used in this study were very long compared with the common clinical practice in the UK (where it is 6 h for solids and 2 h for clear fluids). We appreciate this could have been the standard protocol of the institution, but longer starvation periods would lead to more distress before induction, which possibly could have led to some exclusions from the study. Preoperative anxiety and distress is another significant contributing factor for emergence agitation in children. 2 3 Parental stay during recovery of anaesthesia is another factor influencing emergence agitation in children. 4 We understand the policy of the institution of not having parental presence in PACU influencing the study protocol, and we would like to commend the authors in acknowledging this factor for higher incidence of emergence agitation in Group S.

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BackgroundThe cuff of the laryngeal mask airway (LMA) is preferred to be partially inflated before insertion in pediatric cases. However, it is not known how much inflation is appropriate. In addition, intra-cuff pressure is not routinely monitored in many institutions despite the fact that a neglected high cuff pressure could cause several complications. This study was conducted to determine whether the cuff inflated with its resting volume before insertion could have a clinically tolerable intra-cuff pressure after insertion.MethodsOne hundred fifty unpremedicated children aged 0 to 9 yrs were enrolled. The pilot balloon valve was connected to a piston-free syringe to keep the valve open to the atmosphere and allowing the pressure within the cuff of to LMA to equalize to atmospheric pressure. Anesthesia was induced with 6 vol% of sevoflurane in oxygen. After insertion and final positioning of the LMA, the intra-cuff pressure was measured using a cuff pressure manometer.ResultsThe mean intra-cuff pressure was 50 ± 12.9 cmH2O; intra-cuff pressures were 39.1 ± 9.3, 51.6 ± 11.2, and 64.6 ± 12.5 cmH2O for LMAs of sizes 1.5, 2, and 2.5, respectively. Intra-cuff pressure of more than 60 cmH2O was measured in 26 patients, and the median value was 70 cmH2O. There was weak statistical correlation among age, height, and weight with intra-cuff pressure.ConclusionsThe cuff inflated by the resting volume before insertion may be a simple method for guaranteeing tolerable cuff pressure after insertion.