Oral transmucosal fentanyl

Le résumé fourni par la source

Oral transmucosal fentanyl has been available in the USA for anaesthetic premedication since 1994. The commercial preparation, Fentanyl Oralet® which consists of a raspberry-flavoured, fentanyl-impregnated, sugar-matrix mounted on a stick, has provided anaesthetists with an opportunity to deliver anxiolysis and analgesia to children safely and reliably by a readily acceptable route of administration. Children are encouraged to suck and not bite or chew as 25% of the total dose is absorbed ‘trans-buccally’. This accounts for the early onset of centrally mediated anxiolytic and analgesic effects seen within 15 min of administration. Of the remainder, which is swallowed with saliva, only 25% escapes hepatic first-pass metabolism to become more slowly available systemically [2]. The authors, wanting to evaluate the acceptability of this preparation to children in the UK, manufactured units containing 200, 300 or 400 μg of fentanyl and offered 15 healthy children, aged 3–9 years, presenting for tonsillectomy the choice of having either midazolam syrup or oral transmucosal fentanyl (15–20 μg.kg−1) [1] as part of their premedication. All but one child, who refused it because it resembled a lollipop, chose the new preparation and consumption was, in all cases, complete within 20 min. Twelve children presented in an unsedated yet calm manner and co-operated fully with venous cannulation and induction of anaesthesia. Despite prophylaxis with ondansetron (100 μg.kg−1) postoperative nausea occurred in three children, one of whom vomited. These incidences, though still appreciable, compare with previous observations [1, 3]. Fentanyl Oralets® are currently only commercially available in the USA, where sales approach 20 000 units each year, but the manufacturer is exploring the feasibility of introducing them in the UK. We are encouraged by our provisional findings and would welcome their introduction in the U.K. for further evaluation.

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