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Xu Q, Zou X, Wu J, Duan G, Lan H, Wang L. Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study. Drug Des Devel Ther 2024; 18:1603-1612. [PMID: 38774482 PMCID: PMC11108069 DOI: 10.2147/dddt.s464823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/11/2024] [Indexed: 05/24/2024] Open
Abstract
Background Cough is one of the most common complications following intravenous administration of sufentanil during anesthesia induction. The study aimed to investigate the protective effect of alfentanil, afentanyl derivative with short onset time and short duration, in reducing sufentanil-induced cough. Patients and methods Eighty patients that scheduled for thyroid surgery under general anesthesia were randomly divided into the alfentanil group and normal saline group, with 40 cases per group. Patients in the alfentanil group received intravenous administration of 2 μg/kg alfentanil prior to sufentanil injection during general anesthesia induction, while the same dose of normal saline was administered in the normal saline group. The outcomes measures included the incidence and severity of cough and common side effects of opioids following the administration of sufentanil during the induction of general anesthesia, intraoperative hemodynamics parameters and major adverse events during anesthesia recovery period. Results The incidence of cough within one minute after the injection of sufentanil during anesthesia induction was 40% in the normal saline group, and the pretreatment of alfentanil significantly reduced the incidence of sufentanil-induced cough to 5% (p < 0.05). Correspondingly, the patients in the alfentanil group had decreased severity of sufentanil-induced cough compared with the normal saline group (p < 0.05). No significant differences in the incidences of common side effects of opioids (dizziness, nausea and vomiting, chest tightness and respiratory depression) within one minute after sufentanil injection were found (p > 0.05). Furthermore, there were no significant differences between the two groups in intraoperative hemodynamic parameters, extubation time, or the incidences of emergence agitation, respiratory depression, delayed recovery from anesthesia and postoperative nausea and vomiting during Postanesthesia Care Unit stay (p > 0.05). Conclusion Pretreatment with low-dose alfentanil (2 μg/kg) effectively and safely reduced both the incidence and severity of sufentanil-induced cough during anesthesia induction. Clinical Trial Registration Number Chinese Clinical Trial Registry (identifier: ChiCTR2300069286).
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Affiliation(s)
- Qiaomin Xu
- Department of Anesthesiology, Lishui People’s Hospital, Lishui, 323000, People’s Republic of China
| | - Xintong Zou
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Jimin Wu
- Department of Anesthesiology, Lishui People’s Hospital, Lishui, 323000, People’s Republic of China
| | - Gongchen Duan
- Department of Anesthesiology, Lishui People’s Hospital, Lishui, 323000, People’s Republic of China
| | - Haiyan Lan
- Department of Anesthesiology, Lishui People’s Hospital, Lishui, 323000, People’s Republic of China
| | - Liangrong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
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Phuvachoterojanaphokin N, Watanaboonyongcharoen G, Jinawong S, Munjupong S. Low-dose lidocaine attenuates fentanyl-induced cough: A double-blind randomized controlled trial. Eur J Clin Pharmacol 2022; 78:813-821. [PMID: 35089372 DOI: 10.1007/s00228-022-03282-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The study aimed to determine the efficacy of lidocaine at different low doses to reduce fentanyl-induced cough (FIC). METHODS Three hundred twenty patients aged from 18 to 60 years with ASA I and II scheduled for general anesthesia were randomly assigned to 4 groups to obtain peripheral intravenous 0.9%NaCl (Group I), lidocaine 0.25 mg/kg (Group II), 0.5 mg/kg (Group III) or 1.0 mg/kg (Group IV) 2 min before 3 μg/kg of fentanyl intravenously in a prospective randomized controlled fashion. The primary result was incidence of cough among comparison groups. The secondary results included severity of cough, hemodynamic response and risk factors of FIC. RESULTS Thirty-two, 15, 13 and 11 patients (40, 18.8, 16.3 and 13.8%) presented incidence of cough in Groups I, II, III and IV, respectively (P < 0.05 Group I vs. II, III and IV). No significant difference was observed in the incidence and severity of cough among the lidocaine groups (P > 0.05). Multivariate analysis showed that age ≤ 40 years, nonsmoking and patients not receiving the prior lidocaine injection were risk factors of FIC (P = 0.007, 0.013 and 0.001, respectively). CONCLUSION The study implied intravenous lidocaine 0.25 mg/kg for 2 min before fentanyl injection was the most effective dose to suppress FIC and could be applied in daily practice. Patients aged less than 40 years and nonsmoking were risk factors of FIC, regardless of sex and underlying disease.
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Affiliation(s)
- Nuanwan Phuvachoterojanaphokin
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Grit Watanaboonyongcharoen
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Sarita Jinawong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand.
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Dong Y, Chang X. Comparison of Five Prophylactically Intravenous Drugs in Preventing Opioid-Induced Cough: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2021; 12:684276. [PMID: 34867314 PMCID: PMC8635493 DOI: 10.3389/fphar.2021.684276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Due to the absence of direct comparisons of different therapeutic drugs in preventing opioid-induced cough (OIC) during the induction of general anesthesia, clinicians often faced difficulties in choosing the optimal drug for these patients. Hence, this network meta-analysis was conducted to solve this problem. Methods: Online databases, including Pubmed, Embase, Web of Science, Cochrane, and Google Scholar, were searched comprehensively to identify eligible randomized controlled trials (RCTs), up to March 15th, 2021. Within a Bayesian framework, network meta-analysis was performed by the “gemtc” version 0.8.2 package of R-3.4.0 software, and a pooled risk ratio (RR) associated with 95% credible interval (CrI) was calculated. Results: A total of 20 RCTs were finally enrolled, and the overall heterogeneity for this study was low to moderate. Traditional pair-wise meta-analysis results indicated that all of the five drugs, namely, lidocaine, ketamine, dezocine, butorphanol, and dexmedetomidine could prevent OIC for four clinical outcomes, compared with the placebo (all p-values < 0.05). Moreover, dezocine had the best effect, compared with that of the other drugs (all p-values < 0.05). Network meta-analysis results suggested that the top three rank probabilities for four clinical outcomes from best to worst were dezocine, butorphanol, and ketamine based on individual/cumulative rank plots and surface under the cumulative ranking curve (SUCRA) probabilities. The node-splitting method indicated the consistency of the direct and indirect evidence. Conclusions: Our results indicated that all of these five drugs could prevent OIC compared with the placebo. Moreover, the top three rank probabilities for four clinical outcomes from best to worst were dezocine, butorphanol, and ketamine. Our results were anticipated to provide references for guiding clinical research, and further high-quality RCTs were required to verify our findings. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021243358].
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Affiliation(s)
- Yunxia Dong
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaohan Chang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Dehghanpisheh L, Eghbal M, Bagheri Baravati F, Vatankhah P. Comparison of lidocaine, huffing maneuver and combination of both in prevention fentanyl induced cough before induction of anesthesia: a double-blind, prospective, randomized placebo-controlled study. BMC Anesthesiol 2021; 21:92. [PMID: 33773577 PMCID: PMC7997790 DOI: 10.1186/s12871-021-01313-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intravenous bolus injection of fentanyl has been frequently reported to be associated with cough reflex during patient anesthesia. However, the search for the most effective protocol continues. This study aimed to compare the effect of reducing cough reflex after injection of fentanyl in a fusion protocol by combining the injections of lidocaine and Huffing maneuver and comparing with a placebo control group, before anesthesia induction. METHODS This prospective randomized controlled trial study was performed on 400 patients who were divided into four groups of combined protocol (group 1), lidocaine group (group 2), Huffing maneuver group (group 3), and the control receiving normal saline (group 4). Then patients were injected with 2. 5 μg /kg fentanyl and monitored for 2 min regarding their cough reflex, as well as the severity. RESULTS In group one, 9 patients (9%), in group two, 45 patients (45%), 22 patients (22%) in group three, and in group four, 75 patients (75%), developed cough reflex following fentanyl injection. Also, 13 patients (13%) developed moderate and 4 (4%) developed severe coughs in the control group reported, while no reports of severe or moderate cough were among the intervention groups. There was a significant difference between the intervention group and the control group both in terms of the rate and severity of the fentanyl-induced cough. CONCLUSION By using a combination of lidocaine injection along and Huffing maneuver, better results can be obtained in reducing the frequency, and also the severity of cough followed by fentanyl injection. TRIAL REGISTRATION The trial was registered with IRCT.IR (09/03/2018-No. IRCT20141009019470N74 ).
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Affiliation(s)
- Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadhossein Eghbal
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Bagheri Baravati
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooya Vatankhah
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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5
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Chen R, Tang LH, Sun T, Zeng Z, Zhang YY, Ding K, Meng QT. Mechanism and Management of Fentanyl-Induced Cough. Front Pharmacol 2020; 11:584177. [PMID: 33324214 PMCID: PMC7723435 DOI: 10.3389/fphar.2020.584177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022] Open
Abstract
Fentanyl-induced cough (FIC) often occurs after intravenous bolus administration of fentanyl analogs during induction of general anesthesia and analgesia procedure. The cough is generally benign, but sometimes it causes undesirable side effects, including elevated intra-abdominal, intracranial or intraocular pressure. Therefore, understanding the related mechanisms and influencing factors are of great significance to prevent and treat the cough. This paper reviews the molecular mechanism, influencing factors and preventive administration of FIC, focusing on the efficacy and side effects of various drugs in inhibiting FIC to provide some medical reference for anesthesiologists.
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Affiliation(s)
- Rong Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling-Hua Tang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tao Sun
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zi Zeng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yun-Yan Zhang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Ding
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing-Tao Meng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
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Casaer S, Sebrechts T, Van Houwe P, Rattenberry W. Organizing a safe operating room during a pandemic. What did we learn from COVID-19? ACTA ANAESTHESIOLOGICA BELGICA 2020. [DOI: 10.56126/71.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During the COVID-19 pandemic, multiple guidelines have been issued on hospital safety and protection measures to prevent transmission to healthcare workers and to other patients. The operating room is a high-risk environment where enhanced precautions are required. The guidelines differ and practical implementation between hospitals can also vary, according to interpretation and budget. Staff at risk may question if the local policies are sufficient and correct. This article provides an overview and theoretical background to the additional safety measures required in the operating room during a viral pandemic like the COVID-19 pandemic. This may serve as a touchstone and tool for anesthetists and OR managers.
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Aminnejad R, Salimi A, Saeidi M. Lidocaine during intubation and extubation in patients with coronavirus disease (COVID-19). Can J Anaesth 2020; 67:759. [PMID: 32180173 PMCID: PMC7090453 DOI: 10.1007/s12630-020-01627-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Reza Aminnejad
- Department of Anesthesiology and Critical Care, Qom University of Medical Sciences, Qom, Iran. .,Department of Anesthesiology and Critical Care, Shahid Beheshti Medical University, Tehran, Iran.
| | - Alireza Salimi
- Department of Anesthesiology and Critical Care, Shahid Beheshti Medical University, Tehran, Iran
| | - Mohammad Saeidi
- Department of Anesthesiology and Critical Care, Qom University of Medical Sciences, Qom, Iran
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9
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Gu W, Xu M, Lu H, Huang Q, Wu J. Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial. J Thorac Dis 2019; 11:4663-4670. [PMID: 31903255 DOI: 10.21037/jtd.2019.10.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Dexmedetomidine plus opioid infusion after topical anaesthesia with nebulized lidocaine for cough suppression is a commonly used method for flexible bronchoscopy. Recently, the use of dexmedetomidine as an additive to local anaesthetics has been reported to have several advantages over conventional intravenous administration. However, there are no data regarding the use of nebulized dexmedetomidine-lidocaine for topical anaesthesia as a premedication for flexible bronchoscopy. Therefore, this study compared the tolerability and safety of nebulized dexmedetomidine with that of conventional intravenous administration in patients undergoing bronchoscopy with moderate sedation. Methods Sixty patients requiring flexible bronchoscopy were randomly assigned to three groups: (I) nebulized dexmedetomidine + lidocaine, n=20; (II) intravenous dexmedetomidine + nebulized lidocaine, n=20; and (III) nebulized lidocaine alone (no dexmedetomidine), n=20. The patients' coughing scores were assessed and graded. Our primary hypothesis was that nebulized dexmedetomidine-lidocaine could reduce the incidence of moderate to severe coughing. The secondary endpoints were the rates of glottis closure, complete jaw relaxation and limb movement during the procedure; the elapsed time until recovery; and the dosages of vasoconstrictors and atropine. Results The incidence of moderate to severe coughing was 15% in the nebulized dexmedetomidine group, 50% in the intravenous dexmedetomidine group and 55% in the no dexmedetomidine group. The nebulized dexmedetomidine group had the lowest incidence of moderate to severe coughing (P=0.019). Nebulized dexmedetomidine showed a protective effect for reducing coughing compared with intravenous dexmedetomidine [P=0.008, odds ratio (OR): 0.273, 95% confidence interval (CI): 0.089-0.833]. No differences in the rates of complete jaw relaxation and limb movement during the procedure were observed among the three groups (all P>0.05). The rates of glottis closure were similar (20%, 25%, and 35%; P>0.05). The elapsed time until recovery in the nebulized dexmedetomidine group was significantly shorter than that in the intravenous dexmedetomidine group (10.60±1.39 vs. 15.10±1.45, P<0.001). The vasoconstrictor dosages were significantly lower in the nebulized dexmedetomidine group than in the intravenous dexmedetomidine group (P<0.001). Conclusions Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy was well tolerated during bronchoscopies performed under moderate sedation and was associated with a reduced incidence of moderate to severe coughing, a shorter recovery time and reduced vasoconstrictor consumption.
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Affiliation(s)
- Wei Gu
- Department of Anaesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Meiying Xu
- Department of Anaesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Huijie Lu
- Department of Anaesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Qi Huang
- Department of Anaesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jingxiang Wu
- Department of Anaesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Gupta P, Jindal P, Kumar N. Role of pre-emptive Huff's manoeuvre and acupressure in reducing the incidence of fentanyl induced cough; a risk factor for postoperative nausea vomiting in female patients: A prospective randomised controlled study. Indian J Anaesth 2019; 63:834-840. [PMID: 31649396 PMCID: PMC6798640 DOI: 10.4103/ija.ija_549_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/02/2019] [Accepted: 08/09/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Fentanyl-induced cough is found to occur more often in females and it has been observed to be a risk factor for post-operative nausea and vomiting (PONV). We studied the effect of pre-emptive Huff's manoeuvre and acupressure in reducing incidence of PONV in patients who had fentanyl-induced cough (FIC). METHODS This prospective, experimental and randomised study was conducted on 336 patients who were randomly divided into three groups. Group A (n = 112): acupressure was applied, Group B (n = 112): Huff's manoeuvre was performed and Group C (n = 112) was the control group. Thereafter the patients were given a rapid bolus of injection fentanyl at a dose of 2 μ/kg before induction of anaesthesia. Any episode of cough within 60 seconds of fentanyl administration was classified as FIC, and the severity was graded based on the number of coughs (mild 1 - 2, moderate 3 - 4, and severe 5 or more). The occurrence of PONV was recorded. Statistical analysis done using ANOVA test, Kruskal Wallis. RESULTS Incidence of FIC was 8%, 7.1%, and 25.9% in Acupressure, Huff's and control group respectively. The incidence of PONV was found to be higher in patients who had FIC rather than the patients who did not have FIC. CONCLUSION We conclude that use of Acupressure and Huff's manoeuvre have been demonstrated to be efficacious in reducing FIC and also have an impact in reducing PONV.
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Affiliation(s)
- Parul Gupta
- Department of Anaesthesia and Pain Management, Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun, Uttaranchal, India
| | - Parul Jindal
- Department of Anaesthesia and Pain Management, Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun, Uttaranchal, India
| | - Nidhi Kumar
- Department of Anaesthesia and Pain Management, Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun, Uttaranchal, India
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Lin W, Sun J, Fu S. A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2019; 19:164. [PMID: 31455295 PMCID: PMC6712682 DOI: 10.1186/s12871-019-0836-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/20/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Intravenous use of sufentanil can elicit cough. This study aimed to evaluate the inhibitory effect of pre-injection of a mall dose of remifentanil on sufentanil-induced cough during the induction of general anesthesia. METHODS This prospective, randomized, controlled trial was conducted from January 10, 2019 to March 01, 2019. A total of 100 patients undergoing elective surgery under general anesthesia were enrolled, and at last 84 patients were included and randomly allocated into two equal size groups (n = 42): Patients in the Remifentanil group (R group) received an intravenous infusion of remifentanil 0.3 μg/kg (diluted to 2 ml) 1 min before sufentanil injection; patients in the Control group (C group) received 2 ml of normal saline (NS) at the same time point. Injections of patients in both groups were completed within 5 s. Then, sufentanil 0.5 μg/kg was injected within 5 s and the number of coughs that occurred within 1 min after sufentanil injection were recorded. One minute after sufentanil injection, etomidate 0.3 mg/kg and cisatracurium 0.15 mg/kg were given for general anesthesia induction irrespective of the presence or absence of cough. The mean arterial pressure (MAP) and heart rate (HR) at time points just before remifentanil pretreatment administration (T0), 3 min after administration (T1), 1 min after intubation (T2), and 3 min after intubation (T3) were recorded. RESULTS The incidence of cough in patients in the R group and C group was 4.8 and 31%, respectively. Compared with group C, the incidence and severity of cough in group R was significantly lower (P < 0.01). No significant differences were observed in MAP and HR at the time of general anesthesia induction between the two groups (P > 0.05). CONCLUSION Pretreatment with a small dose of remifentanil effectively and safely reduced the incidence and severity of cough induced by sufentanil during anesthesia induction and can be used as an alternative treatment to inhibit coughing caused by sufentanil. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR1900020587, registered date: January 9, 2019), http://www.chictr.org.cn.
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Affiliation(s)
- Wendong Lin
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jiehao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shuying Fu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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12
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Zhou W, Zhang D, Tian S, Yang Y, Xing Z, Ma R, Zhou T, Bao T, Sun J, Zhang Z. Optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough suppression: a prospective randomized controlled trial. BMC Anesthesiol 2019; 19:89. [PMID: 31153360 PMCID: PMC6545214 DOI: 10.1186/s12871-019-0765-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/22/2019] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough (FIC) suppression. Methods Patients of 180 undergoing elective surgery with general anesthesia, aged 18–65 years, BMI 18.5–30 kg/m2, ASA I or II, were equally randomized into four groups (n = 45) to receive intravenous pretreatment of dexmedetomidine with 0 (group 1), 0.3 (group 2), 0.6 (group 3) and 0.9 (group 4) mcg/kg over 10 mins, respectively. After the pretreatment, all patients were given a 5-s intravenous injection of fentanyl 4 mcg/kg. The symptoms of irritating cough including the severity and onset time were recorded for 1 min after fentanyl injection. General anesthesia induction was completed with midazolam, propofol and cisatracurium, then endotracheal tube or laryngeal mask was inserted and connected to an anesthesia machine. MAP, HR and SpO2 at the beginning of pretreatment (T0), 3 min (T1), 6 min (T2), 9 min (T3) and 12 min (T4) after the beginning of pretreatment were recorded. Side effects of dexmedetomidine, such as bradycardia, hypertension, hypotension, and respiratory depression were also recorded during the course. Results Totally 168 patients completed the study. The incidences of cough were 52.4, 42.9, 11.9, and 14.3% in groups 1, 2, 3, and 4, respectively, with no significant differences between groups 1 and 2 (P > 0.05) and between groups 3 and 4 (P > 0.05). The incidence and severity of cough in groups 3 and 4 were significantly lower than those in groups 1 and 2 (P < 0.05). Compared to T0, HR at T2 (P < 0.05), T3 (P < 0.01), and T4 (P < 0.01) decreased significantly and MAP at T4 decreased significantly (P < 0.05) in group 4. Bradycardia occurred in 1 case and respiratory depression occurred in 1 case in group 4. Compared to group 1, the onset time of cough in the other 3 groups were delayed significantly (P < 0.05). Conclusion Pretreated dexmedetomidine 0.6 mcg/kg blous intravenous infusion over 10 mins could reduce FIC effectively without side effects. Trial registration This study was registered in ClinicalTrials.gov (NCT03126422), April 13, 2017.
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Affiliation(s)
- Wei Zhou
- School of Medicine, Yangzhou University, Yangzhou, 225009, China
| | - Dongsheng Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Shunping Tian
- School of Medicine, Yangzhou University, Yangzhou, 225009, China
| | - Yang Yang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Zhi Xing
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Rongrong Ma
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Tianqi Zhou
- Preventive Health Care Office, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Tianxiu Bao
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Jianhong Sun
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Zhuan Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China.
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13
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Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway: A multicentre randomised controlled trial. Eur J Anaesthesiol 2019; 35:588-597. [PMID: 29916859 PMCID: PMC6072370 DOI: 10.1097/eja.0000000000000852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Avoidance of airway complications and rapid emergence from anaesthesia are indispensable for the use of a laryngeal mask airway (LMA). Evidence from adequately powered randomised studies with a low risk of bias for the optimal anaesthetic in this context is limited. OBJECTIVE We tested the hypothesis that when using remifentanil-based intra-operative analgesia, desflurane would be the most suitable anaesthetic: with noninferiority in the occurrence of upper airway complications and superiority in emergence times compared with sevoflurane or propofol. DESIGN A randomised, multicentre, partially double-blinded, three-arm, parallel-group study. SETTING Two university and two regional German hospitals, from February to October 2015. PATIENTS A total of 352 patients (age 18 to 75 years, ASA physical status I to III, BMI less than 35 kg m−2 and fluent in German) were enrolled in this study. All surgery was elective with a duration of 0.5 to 2 h, and general anaesthesia with a LMA was feasible. INTERVENTION The patients were randomised to receive desflurane, sevoflurane or propofol anaesthesia. MAIN OUTCOME MEASURES This study was powered for the primary outcome ‘time to state date of birth’ and the secondary outcome ‘intra-operative cough’. Time to emergence from anaesthesia and the incidence of upper airway complications were assessed on the day of surgery. RESULTS The primary outcome was analysed for 343 patients: desflurane (n=114), sevoflurane (n=111) and propofol (n=118). The desflurane group had the fastest emergence. The mean (± SD) times to state the date of birth following desflurane, sevoflurane and propofol were 8.1 ± 3.6, 10.1 ± 4.0 and 9.8 ± 5.1 min, respectively (P < 0.01). There was no difference in upper airway complications (cough and laryngospasm) across the groups, but these complications were less frequent than in previous studies. CONCLUSION When using a remifentanil infusion for intra-operative analgesia in association with a LMA, desflurane was associated with a significantly faster emergence and noninferiority in the incidence of intra-operative cough than either sevoflurane or Propofol. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02322502; EudraCT identifier: 2014-003810-96.
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Zhang J, Miao S, Tu Q, Shi M, Zou L, Liu S, Wang G. Effect of butorphanol on opioid-induced cough: a meta-analysis of randomized controlled trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3263-3268. [PMID: 30323559 PMCID: PMC6173179 DOI: 10.2147/dddt.s180533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to assess the effect of butorphanol on the prevention of opioid-induced cough by a meta-analysis. Materials and methods We searched PubMed, Embase, The Cochrane Library, and the China National Knowledge Infrastructure database for relevant randomized controlled trials (RCTs) to demonstrate the efficacy of butorphanol on the prevention of opioid-induced cough. We used RevMan 5.3 to conduct a meta-analysis on each outcome. Results Eight RCTs comparing 942 patients were included in this study. The pooled meta-analysis showed that the incidence of opioid-induced cough in the butorphanol group was significantly decreased compared with that of the control group (risk ratio [RR]=0.17, 95% CI [0.09, 0.33], P<0.00001). Incidences of opioid-induced cough in the butorphanol group resulting in mild cough (RR=0.30, 95% CI [0.11, 0.78], P=0.01), moderate cough (RR=0.08, 95% CI [0.03, 0.22], P<0.00001), or severe cough (RR=0.08, 95% CI [0.02, 0.30], P=0.0001) were significantly lower than those of the control group. Conclusion This meta-analysis suggested that butorphanol can effectively prevent the incidence of opioid-induced cough and reduce the severity of opioid-induced cough.
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Affiliation(s)
- Jian Zhang
- Department of Anesthesiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Shuai Miao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
| | - Qing Tu
- Department of Anesthesiology, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, Hebei, China
| | - Mengzhu Shi
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
| | - Lan Zou
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
| | - Su Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
| | - Guanglei Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
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Beaussier M, Delbos A, Maurice-Szamburski A, Ecoffey C, Mercadal L. Perioperative Use of Intravenous Lidocaine. Drugs 2018; 78:1229-1246. [DOI: 10.1007/s40265-018-0955-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Tan W, Li S, Liu X, Gao X, Huang W, Guo J, Wang Z. Prophylactic Intravenous Lidocaine at Different Doses for Fentanyl-Induced Cough (FIC): A Meta-Analysis. Sci Rep 2018; 8:9946. [PMID: 29967371 PMCID: PMC6028622 DOI: 10.1038/s41598-018-27457-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/25/2018] [Indexed: 12/23/2022] Open
Abstract
To evaluate whether different doses of intravenous lidocaine are effective at preventing fentanyl-induced cough (FIC), we searched PubMed, Scopus, Cochrane Library, EMBASE and Web of Science, according to predefined criteria, for all articles published until June 2017. A meta-analysis and subgroup analysis were performed by combining the reported incidence of FIC. The odds ratio (OR) was used as a summary statistic. Eleven articles were included, with 965 patients in the lidocaine group and 745 patients in the control group. A pooled analysis indicated that the overall incidence of FIC was significantly different between the lidocaine group and the control group (OR, 0.27; 95% confidence interval (CI), 0.21-0.35; P < 0.05), as well as between the adult and paediatric subgroups. Sensitivity analysis showed that the results were stable. Subgroup analyses showed that compared to a placebo, both low (0.5-1.0 mg/kg) and high doses of lidocaine (1.5-2.0 mg/kg) were effective at reducing FIC incidence. There was no significant difference between low or high doses of lidocaine. Fentanyl doses added no significant heterogeneity as shown by meta-regression. The findings of this meta-analysis indicate that prophylactic intravenous lidocaine is effective at preventing FIC in both adults and children.
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Affiliation(s)
- Wulin Tan
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Si Li
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiaochen Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiang Gao
- Department of Pharmacy, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wenqi Huang
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Junying Guo
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
| | - Zhongxing Wang
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
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Goyal VK, Bhargava SK, Baj B. Effect of preoperative incentive spirometry on fentanyl-induced cough: a prospective, randomized, controlled study. Korean J Anesthesiol 2017; 70:550-554. [PMID: 29046775 PMCID: PMC5645588 DOI: 10.4097/kjae.2017.70.5.550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 11/26/2022] Open
Abstract
Background Fentanyl-induced cough (FIC) has a reported incidence of 13–65% on induction of anesthesia. Incentive spirometry (IS) creates forceful inspiration, while stretching pulmonary receptors. We postulated that spirometry just before the fentanyl (F) bolus would decrease the incidence and severity of FIC. Methods This study enrolled 200 patients aged 18–60 years and with American Society of Anesthesiologists status I or II. The patients were allocated to two groups of 100 patients each depending on whether they received preoperative incentive spirometry before fentanyl administration. Patients in the F+IS group performed incentive spirometry 10 times just before an intravenous bolus of 3 µg/kg fentanyl in the operating room. The onset time and number of coughs after fentanyl injection were recorded as primary outcomes. Any significant changes in blood pressure, heart rate, or adverse effects of the drug were recorded as secondary outcomes. Results Patients in the F+IS group had a significantly lower incidence of FIC than in the F group (6% vs. 26%) (P < 0.05). The severity of cough in the F+IS group was also significantly lower than that in group F (mild, 5 vs. 17; moderate 1 vs. 7; severe, 0 vs. 2) (P < 0.05). The median onset time was comparable in both groups (9 s [range: 6–12 s] in both groups). Conclusions Preoperative incentive spirometry significantly reduces the incidence and severity of FIC when performed just before fentanyl administration.
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Affiliation(s)
- Vipin Kumar Goyal
- Department of Anesthesiology, Mahatma Gandhi Medical College, Jaipur, India
| | | | - Birbal Baj
- Department of Anesthesiology, Mahatma Gandhi Medical College, Jaipur, India
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Ozmen O, Kara D, Karaman EU, Karakoc F, Karakaya MA, Arslan Z. Pheniramine Maleate is more effective than Lidocaine on Fentanyl Induced Cough. Pak J Med Sci 2016; 32:715-9. [PMID: 27375720 PMCID: PMC4928429 DOI: 10.12669/pjms.323.9496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Fentanyl is frequently used during anesthesia induction. The use of fentanyl can cause cough through different mechanisms. Here, we aimed to investigate effects of pheniramine maleate (PM), an antihistaminic agent, and compare it with lidocaine on fentanyl induced cough. METHODS This is a randomized double-blind prospective clinical study of ASA I-II, 120 patients scheduled for elective abdominal surgery. Patients were administered drugs intravenously and randomly allocated into three groups: Group C (2 ml 0.9 % normal saline), Group L (1mg/kg lidocaine), and Group F (PM 45.5 mg). 90 seconds after administration, 2µ/kg fentanyl was applied in three seconds to all patients. Severity of cough (mild: 1-2, moderate: 3-5, severe> 5), time of the cough and vital parameters were recorded 90 seconds after fentanyl injection. RESULTS Eight patients (25%) in Group C had fentanyl induced cough whereas three patients (7.5%) in Group L and one patient (2.5%) in Group F experienced this phenomenon. There was statistically significant difference between Group F and Group C (p<0.05); however, differences between Group L and Group C or Group F and Group L were not statistically significant (p>0.05). CONCLUSIONS Pheniramine Maleate 45.5 mg is better that placebo and as effective as lidocaine to prevent fentanyl induced cough.
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Affiliation(s)
- Ozgur Ozmen
- Dr. Ozgur Ozmen, Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Duygu Kara
- Dr. Duygu Kara, Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Emine Uzlas Karaman
- Dr. Emine Uzlas Karaman, Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Fatma Karakoc
- Dr. Fatma Karakoc, Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Muhammet Ahmet Karakaya
- Dr. Muhammet Ahmet Karakaya, Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Zakir Arslan
- Dr. Zakir Arslan, Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Shuying L, Ping L, Juan N, Dong L. Different interventions in preventing opioid-induced cough: a meta-analysis. J Clin Anesth 2016; 34:440-7. [PMID: 27687431 DOI: 10.1016/j.jclinane.2016.05.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cough is one of the most common complications of opioids. Many studies have evaluated the effect of various drugs in preventing opioid-induced cough (OIC). However, there is existing controversy about those reports. The present study was performed to assess the efficacy of different interventions on OIC. METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Embase to identify randomized controlled trials on the efficacy of different drugs in the prevention of OIC. Opioids included fentanyl, sufentanil, and remifentanil. We mainly investigated the incidence and severity of OIC after different interventions. RESULTS Thirty-four trials including 9906 patients were analyzed in this study. Twenty different drugs were reported, and 10 drugs were indentified in more than 2 articles. These drugs, including lidocaine, ketamine, dexmedetomidine, priming of fentanyl, propofol, dezocine, dexamethasone, dextromethorphan, and magnesium sulfate (MgSO4), showed a significant efficacy compared with controls. There were insufficient numbers of trials for salbutamol, clonidine, tramadol, pentazocine, rocuronium, midazolam, atropine, terbutaline, sodium chromoglycate, beclomethasone, and ephedrine. From these data, we found that salbutamol, tramadol, midazolam, and atropine were ineffective. CONCLUSIONS This meta-analysis suggested that the prophylactic administration of lidocaine, ketamine, dexmedetomidine, priming of fentanyl, propofol, and dezocine was effective in preventing OIC.
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Affiliation(s)
- Li Shuying
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China
| | - Li Ping
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China
| | - Ni Juan
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China
| | - Luo Dong
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China.
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Solanki SL, Doctor JR, Kapila SJ, Gehdoo RP, Divatia JV. Acupressure versus dilution of fentanyl to reduce incidence of fentanyl-induced cough in female cancer patients: a prospective randomized controlled study. Korean J Anesthesiol 2016; 69:234-8. [PMID: 27274367 PMCID: PMC4891534 DOI: 10.4097/kjae.2016.69.3.234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fentanyl-induced cough (FIC) is a transient condition with a reported incidence of 18% to 65% depending on the dose and route of administration of fentanyl. Nonpharmacological methods to prevent FIC are more cost-effective than medications. Dilution of fentanyl has a proven role in the prevention of FIC. Acupressure can also prevent FIC because it has a proven role in the treatment of cough. METHODS This study included 225 female patients with an American Society of Anesthesiologists physical status of I or II who were randomly divided into 3 groups of 75 patients each. Patients in the control group received undiluted fentanyl at 3 µg/kg, patients in the acupressure group received undiluted fentanyl at 3 µg/kg with acupressure, and patients in the dilution group received diluted fentanyl at 3 µg/kg. Coughing was noted within 2 min of fentanyl administration. The severity of FIC was graded as mild (1-2 coughs), moderate (3-4 coughs), or severe (≥5 coughs). The timing of coughs was also noted. RESULTS The incidence of FIC was 12.7% in the control group, 6.8% in the dilution group, and 1.3% in the acupressure group. The difference in the incidence of cough was statistically significant (P = 0.008) between the control and acupressure groups. The difference in the severity of cough among the groups was not statistically significant. The median onset time of cough among all groups was 9 to 12 seconds. CONCLUSIONS The application of acupressure prior to administration of fentanyl significantly reduces the incidence of FIC. Dilution of fentanyl also reduces the incidence of FIC, but the difference is not statistically significant.
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Affiliation(s)
- Sohan Lal Solanki
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Center, Mumbai, India
| | - Jeson Rajan Doctor
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Center, Mumbai, India
| | - Savi J Kapila
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Center, Mumbai, India
| | - Raghbirsingh P Gehdoo
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Center, Mumbai, India
| | - Jigeeshu V Divatia
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Center, Mumbai, India
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[The effect of pheniramine on fentanyl-induced cough: a randomized, double blinded, placebo controlled clinical study]. Rev Bras Anestesiol 2016; 66:383-7. [PMID: 27155780 DOI: 10.1016/j.bjan.2015.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/26/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are many studies conducted on reducing the frequency and severity of fentayl-induced cough during anesthesia induction. We propose that pheniramine maleate, an antihistaminic, may suppress this cough. We aim to observe the effect of pheniramine on fentanyl-induced cough during anesthesia induction. METHODS This is a double-blinded, prospective, three-arm parallel, randomized clinical trial of 120 patients with ASA (American Society of Anesthesiologists) physical status III and IV who aged ≥18 and scheduled for elective open heart surgery during general anesthesia. Patients were randomly assigned to three groups of 40 patients, using computer-generated random numbers: placebo group, pheniramine group, and lidocaine group. RESULTS Cough incidence differed significantly between groups. In the placebo group, 37.5% of patients had cough, whereas the frequency was significantly decreased in pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p=0.0007 and p=0.0188, respectively). There was no significant change in cough incidence between pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p=0.4325). Cough severity did also change between groups. Post Hoc tests with Bonferroni showed that mean cough severity in placebo differed significantly than that of pheniramine group and lidocaine group (p<0.0001 and p=0.009, respectively). There was no significant change in cough severity between pheniramine group and lidocaine group (p=0.856). CONCLUSION Intravenous pheniramine is as effective as lidocaine in preventing fentayl-induced cough. Our results emphasize that pheniramine is a convenient drug to decrease this cough.
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Arslan Z, Çalık ES, Kaplan B, Ahiskalioglu EO. The effect of pheniramine on fentanyl-induced cough: a randomized, double blinded, placebo controlled clinical study. Braz J Anesthesiol 2015; 66:383-7. [PMID: 27343788 DOI: 10.1016/j.bjane.2014.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/26/2014] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are many studies conducted on reducing the frequency and severity of fentayl-induced cough during anesthesia induction. We propose that pheniramine maleate, an antihistaminic, may suppress this cough. We aim to observe the effect of pheniramine on fentanyl-induced cough during anesthesia induction. METHODS This is a double-blinded, prospective, three-arm parallel, randomized clinical trial of 120 patients with ASA (American Society of Anesthesiologists) physical status III and IV who aged ≥18 and scheduled for elective open heart surgery during general anesthesia. Patients were randomly assigned to three groups of 40 patients, using computer-generated random numbers: placebo group, pheniramine group, and lidocaine group. RESULTS Cough incidence differed significantly between groups. In the placebo group, 37.5% of patients had cough, whereas the frequency was significantly decreased in pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p=0.0007 and p=0.0188, respectively). There was no significant change in cough incidence between pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p=0.4325). Cough severity did also change between groups. Post Hoc tests with Bonferroni showed that mean cough severity in placebo differed significantly than that of pheniramine group and lidocaine group (p<0.0001 and p=0.009, respectively). There was no significant change in cough severity between pheniramine group and lidocaine group (p=0.856). CONCLUSION Intravenous pheniramine is as effective as lidocaine in preventing fentayl-induced cough. Our results emphasize that pheniramine is a convenient drug to decrease this cough.
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Affiliation(s)
- Zakir Arslan
- Regional Training and Research Hospital, Department of Anesthesiology and Intensive Care, Erzurum, Turkey.
| | - Eyup Serhat Çalık
- Regional Training and Research Hospital, Department of Cardiac Surgery, Erzurum, Turkey
| | - Bekir Kaplan
- Regional Training and Research Hospital, Department of Anesthesiology and Intensive Care, Erzurum, Turkey
| | - Elif Oral Ahiskalioglu
- Regional Training and Research Hospital, Department of Anesthesiology and Intensive Care, Erzurum, Turkey
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Kim JE, Min SK, Chae YJ, Lee YJ, Moon BK, Kim JY. Pharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis. J Anesth 2014; 28:257-66. [PMID: 23958914 DOI: 10.1007/s00540-013-1695-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022]
Abstract
Fentanyl-induced cough (FIC) is often observed after intravenous bolus administration of fentanyl during anesthesia induction. This meta-analysis assessed the efficacy of pharmacological and nonpharmacological interventions to reduce the incidence of FIC. We searched for randomized controlled trials comparing pharmacological or nonpharmacological interventions with controls to prevent FIC; we included 28 studies retrieved from Pub-Med, Embase, and Cochrane Library. Overall incidence of FIC was approximately 31 %. Lidocaine [odds ratio (OR) = 0.29, 95 % confidence interval (CI) 0.21–0.39], N-methyl-D-aspartate (NMDA) receptor antagonists (OR 0.09, 95 % CI 0.02–0.42), propofol (OR 0.07, 95 % CI 0.01–0.36), a2 agonists (OR 0.32, 95 % CI 0.21–0.48), b2 agonists (OR 0.10, 95 % CI 0.03–0.30), fentanyl priming (OR 0.33, 95 % CI 0.19–0.56), and slow injection of fentanyl (OR 0.25, 95 % CI 0.11–0.58)] were effective in decreasing the incidence of FIC, whereas atropine (OR 1.10, 95 % CI 0.58–2.11) and benzodiazepines (OR 2.04, 95 % CI 1.33–3.13) were not effective. This meta-analysis found that lidocaine, NMDA receptor antagonists, propofol, a2 agonists, b2 agonists, and priming dose of fentanyl were effective in preventing FIC, but atropine and benzodiazepines were not. Slow injection of fentanyl was effective in preventing FIC, but results depend on the speed of administration.
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Mesbah Kiaee M, Safari S, Movaseghi GR, Mohaghegh Dolatabadi MR, Ghorbanlo M, Etemadi M, Amiri SA, Zamani MM. The effect of intravenous magnesium sulfate and lidocaine in hemodynamic responses to endotracheal intubation in elective coronary artery bypass grafting: a randomized controlled clinical trial. Anesth Pain Med 2014; 4:e15905. [PMID: 25237632 PMCID: PMC4164986 DOI: 10.5812/aapm.15905] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/21/2013] [Accepted: 01/08/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There have been many concerns about alteration in hemodynamic parameters within and shortly after endotracheal intubation (ETI) in patients scheduled for elective coronary artery bypass grafting (CABG). OBJECTIVES We compared the attenuation effect of magnesium sulfate and lidocaine on hemodynamic responses after ETI, in patients undergoing CABG. PATIENTS AND METHODS In this randomized controlled trial 150 patients undergoing elective CABG were enrolled. Included patients were randomly allocated to three groups and received lidocaine (1.5 mg/kg), magnesium sulfate (50 mg/kg within five minute), or normal saline, 90 seconds before ETI. Baseline hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded immediately before anesthesia induction, before intubation, immediately after intubation, and at second and fifth minutes after intubation. RESULTS The baseline hemodynamic variables had no deference among the three groups. HR between intubation and five minute after intubation was significantly lower in two groups received lidocaine or magnesium sulfate in comparison with placebo group. Lidocaine induced more than 20% decrease in HR and MAP immediately after intubation; hence, lidocaine group showed significant MAP reduction in comparison with the two other groups. CONCLUSIONS Lidocaine induced hemodynamic instability but premedication of magnesium sulfate maintained hemodynamic stability after intubation. Therefore, in patients undergoing CABG who received high-dose intravenous analgesic for general anesthesia, the administration of magnesium sulfate might result in maintaining hemodynamic stability after ETI in comparison with lidocaine.
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Affiliation(s)
- Mehrdad Mesbah Kiaee
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Safari
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Movaseghi
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Masoud Ghorbanlo
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Etemadi
- Students' Scientific Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Arash Amiri
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Zamani
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Shen JC, Xu JG, Zhou ZQ, Liu HJ, Yang JJ. Effect of equivalent doses of fentanyl, sufentanil, and remifentanil on the incidence and severity of cough in patients undergoing abdominal surgery: A prospective, randomized, double-blind study. Curr Ther Res Clin Exp 2014; 69:480-7. [PMID: 24692822 DOI: 10.1016/j.curtheres.2008.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2008] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fentanyl congeners have been found to induce cough during induction of general anesthesia. Studies of fentanyl and sufentanil have found incidence rates of 28% to 65% and 15%, respectively. However, no study has assessed the occurrence of cough induced by remifentanil. OBJECTIVE The aim of this study was to assess the effect of equivalent doses of fentanyl, sufentanil, and remifentanil on cough. METHODS Patients rated American Society of Anesthesiologists class I or II of either sex, aged 18 to 60 years, who were scheduled for elective abdominal surgery with general anesthesia were randomly and equally assigned to 3 groups using a computer-generated table of random numbers. The patients received equivalent doses of fentanyl 2 μg/kg, sufentanil 0.2 μg/kg, or remifentanil 2 μg/kg via IV push. Vital signs (systolic blood pressure [SBP], heart rate [HR], and oxygen saturation via pulse oximetry [SpO2]) and the occurrence and severity of cough were recorded for 2 minutes after drug administration by an anesthesiologist who was blinded to the drug treatment. The severity of cough was graded as none (0), mild (1-2), moderate (3-5), or severe (>5). RESULTS A total of 315 Chinese patients (197 women, 118 men; mean [SD] age, 37.9 [10.4] years) were approached for enrollment and assigned to 3 groups of 105 patients each; all patients completed the study protocol. The 3 treatment groups were similar in terms of demographic characteristics and type of abdominal surgery. The incidence of cough was significantly greater in the remifentanil group (57 [54.3%] patients) than in the fentanyl group (35 [33.3%]; P < 0.01) or the sufentanil group (32 [30.5%]; P < 0.01). The severity of cough was significantly greater in the remifentanil group (severe, moderate, mild, none: 24, 7, 26, 48) than in the fentanyl (7, 9, 19, 70; P < 0.01) or sufentanil group (4, 2, 26, 73; P < 0.01). In all 3 groups, when the patients coughed, significant increases were observed in their SBP (128 [12]-139 [16] mm Hg; P < 0.01) and HR (74 [10]-87 [16] beats/min; P < 0.01). Within 2 minutes after drug administration, 62 patients (59%) in the remifentanil group experienced hypoxemia (SpO2 <90%) necessitating manually assisted mask ventilation, while no patients experienced hypoxemia in the fentanyl or sufentanil group. Three patients (2.9%) in the remifentanil group experienced muscle rigidity and deterioration of SBP, HR, and SpO2. No other adverse events were recorded. Cunclusion: Remifentanil was associated with a significantly greater incidence and severity of cough than equivalent doses of fentanyl or sufentanil. Fentanyl and sufentanil appeared comparable in these Chinese patients undergoing abdominal surgery.
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Affiliation(s)
- Jin-Chun Shen
- Department of Anesthesiology, Jinling Hospital, Nanjing University, Nanjing, China
| | - Jian-Guo Xu
- Department of Anesthesiology, Jinling Hospital, Nanjing University, Nanjing, China
| | - Zhi-Qiang Zhou
- Department of Anesthesiology, Jinling Hospital, Nanjing University, Nanjing, China
| | - Hong-Jun Liu
- Department of Anesthesiology, Jinling Hospital, Nanjing University, Nanjing, China
| | - Jian-Jun Yang
- Department of Anesthesiology, Jinling Hospital, Nanjing University, Nanjing, China
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Comparison of the effects of ketamine or lidocaine on fentanyl-induced cough in patients undergoing surgery: A prospective, double-blind, randomized, placebo-controlled study. Curr Ther Res Clin Exp 2014; 71:289-97. [PMID: 24688150 DOI: 10.1016/j.curtheres.2010.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fentanyl-induced cough is common but has not been viewed as a serious anesthetic problem. However, the cough may be explosive at times, may require immediate intervention, and may be associated with undesirable increases in intracranial, intraocular, and intra-abdominal pressures. Prevention of fentanylinduced cough in such situations is of paramount importance. Ketamine, at concentrations achieved with standard clinical doses, has a direct relaxant effect on airway smooth muscle. OBJECTIVE This study was designed to assess the effects of ketamine or lidocaine on fentanyl-induced cough. METHODS This double-blind, randomized, placebo-controlled study was conducted at the Erciyes University Medical School, Kayseri, Turkey. Consecutive adult patients aged 18 to 65 years and classified as American Society of Anesthesiologists physical status I or II who were undergoing elective surgery with general anesthesia were enrolled. Patients were randomly allocated equally into 3 groups to receive lidocaine 1 mg/kg, ketamine 0.5 μg/kg, or placebo intravenously 1 minute before fentanyl administration. Following intravenous fentanyl (1.5 μg/kg over 2 seconds) injection, an observer, unaware of the type of medication given to the patients, recorded the number of episodes of coughing, if any. Any episode of cough was classified as coughing and graded by investigators blinded to treatment as mild (1-2 coughs), moderate (3-4), or severe (≥5). Blood pressure, heart rate, pulse oximetry oxygen saturation (SpO2), and adverse effects (AEs) were recorded. RESULTS A total of 368 patients were approached for inclusion; 300 patients met the inclusion criteria and were enrolled in the study. No patients in the ketamine group had cough. The frequency of cough was significantly lower in the lidocaine (11/100 [11%]; P = 0.024) and ketamine (0/100; P = 0.001) groups compared with the placebo group (23/100 [23%]). The intensity of cough was significantly lower in the lidocaine (mild, 7/100 [7%]; moderate, 4/100 [4%]; P = 0.037) and ketamine (0/100; P < 0.001) groups compared with the placebo group (mild, 10/100 [10%]; moderate, 12/100 [12%]; severe, 1/100 [1%]). Severe cough (≥5) was observed in 1 patient in the placebo group. Incidence and intensity of cough were significantly decreased in the ketamine group compared with the lidocaine group (incidence, P = 0.001; intensity, P = 0.003). There were no significant differences between groups with respect to systolic blood pressure, diastolic blood pressure, heart rate, SpO2, and AEs. CONCLUSION Intravenous ketamine (0.5 mg/kg) significantly reduced the reflex cough induced by fentanyl compared with lidocaine and placebo, and was well tolerated.
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Abstract
This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu.
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Affiliation(s)
- Joyce A Generali
- Editor-in-Chief, Hospital Pharmacy, and Clinical Professor, Emeritus, Department of Pharmacy Practice, University of Kansas, School of Pharmacy, Kansas City/Lawrence, Kansas, e-mail:
| | - Dennis J Cada
- Founder and Contributing Editor, The Formulary, and Editor, Off-Label Drug Facts, e-mail:
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Sun L, Guo R, Sun L. The impact of prophylactic intravenous lidocaine on opioid-induced cough: a meta-analysis of randomized controlled trials. J Anesth 2013; 28:325-33. [PMID: 24173406 DOI: 10.1007/s00540-013-1732-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Opioids are commonly used for general anesthesia, but reflex cough can occur after an intravenous injection. We have performed a meta-analysis of randomized controlled trials (RCTs) that evaluated the effectiveness and safety of prophylactic lidocaine administered intravenously (IV) on opioid-induced cough (OIC) during induction in patients undergoing general anesthesia. METHODS We searched three bibliographic databases (PubMed, Embase, and the Cochrane Central Register of Controlled Trials) to identify studies meeting a priori inclusion criteria and also conducted a secondary reference review. The information used to calculate the relationship between lidocaine prophylaxis and the risk and severity of OIC was extracted by two principal investigators, respectively. RESULTS Six RCTs with a total of 1,740 participants were included in this meta-analysis. Overall, prophylactic lidocaine administered IV reduced both the risk of OIC [pooled risk ratio (RR) 0.471; 95 % confidence interval (CI) 0.355-0.625; P = 0.074; heterogeneity test, I (2) = 50.3 %] and its severity (weighed mean difference -0.316; 95 % CI -0.480 to -0.151; P = 0.038; heterogeneity test, I (2) = 60.5 %). Sub-group analysis indicated a significant reduction in the incidence of both fentanyl-induced cough (FIC) and remifentanil-induced cough (RIC), but it appeared that lidocaine only alleviated the severity of FIC. Further sub-group analysis indicated that the lowest effect dose of lidocaine for preventing the prevalence of OIC was 0.5 mg/kg. No severe adverse effects were reported. CONCLUSIONS Our meta-analysis establishes the effectiveness of prophylactic lidocaine administered IV for the prevention of OIC during induction. The lowest effective dose of lidocaine on the risk of OIC appeared to be 0.5 mg/kg.
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Affiliation(s)
- Liang Sun
- Department of Anesthesiology, Cancer Institute and Hospital, National Cancer Center, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli Road, Chaoyang District, Beijing, 100021, China
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Gecaj-Gashi A, Nikolova-Todorova Z, Ismaili-Jaha V, Gashi M. Intravenous lidocaine suppresses fentanyl-induced cough in Children. Cough 2013; 9:20. [PMID: 23947795 PMCID: PMC3751768 DOI: 10.1186/1745-9974-9-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE Fentanyl-induced cough is usually mild and transitory, but it can be undesirable in patients with increased intracranial pressure, open wounds of the eye, dissecting aortic aneurism, pneumothorax, and reactive airway disease. The aim of this study is to evaluate the efficacy of lidocaine in suppressing fentanyl-induced cough in children during induction in general anesthesia. METHODS One hundred and eighty-six children of both sexes, aged between 4-10 years, ASA physical status I and II, and scheduled for elective surgery, were recruited for the study. Patients with a history of bronchial asthma, obstructive pulmonary disease, or infections of the respiratory tract were excluded. Patients were randomly allocated to three equal groups (n = 62) to receive 1.0 mg/kg lidocaine (Group I), 0.5 mg/kg lidocaine (Group II), or placebo (equal volume of 0.9% saline; Group III). Each was administered over 5 s one minute before intravenous (IV) administration of fentanyl 2-3 μg/kg during induction in general anesthesia. The severity of coughing was graded by counting the number of episodes of cough: mild (1-2), moderate (3-4) or severe (5 or more). RESULTS Demographic information was comparable between groups. The most frequent coughing was observed in the placebo group (Group III; 43.5%), of whom 4.8% (three patients) were graded with severe cough. In Group II, 22.6% patients had cough, of which 1.6% (one patient) was graded as severe. In Group I, 16.1% patients had cough, none of whom were graded as severe. CONCLUSION Our results demonstrate that IV lidocaine can markedly suppress fentanyl-induced cough in children, even in doses as low as 0.5 mg/kg.
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Affiliation(s)
- Agreta Gecaj-Gashi
- Clinic of Anesthesiology & Intensive Care, University Clinical Centre of Kosova, 10000, Prishtina, Republic of Kosova
| | - Zorica Nikolova-Todorova
- Clinic of Anesthesiology & Reanimatology and Intensive Care, University Clinical Centre of Skopje, Skopje, Republic of Macedonia
| | - Vlora Ismaili-Jaha
- Pediatric Clinic, University Clinical Centre of Kosova, Prishtina, Republic of Kosova
| | - Musli Gashi
- Emergency Center, University Clinical Centre of Kosova, Prishtina, Kosova
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Jung HJ, Kim JB, Im KS, Cho HJ, Kim JW, Lee JM. Effects of a priming dose of fentanyl during anaesthesia on the incidence and severity of fentanyl-induced cough in current, former and non-smokers. J Int Med Res 2012; 39:2379-84. [PMID: 22289557 DOI: 10.1177/147323001103900638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fentanyl is commonly used during anaesthesia and can cause fentanyl-induced cough (FIC). This study investigated whether a priming dose of fentanyl reduced FIC, and determined the factors associated with increased risk of FIC. Subjects undergoing elective surgery under general anaesthesia (n = 800) were randomized into four groups: group 1 received 2 μg/kg fentanyl bolus; groups 2, 3 and 4 received a priming dose of fentanyl 0.5 μg/kg followed by 1.5 μg/kg after 1, 2 or 3 min, respectively. The incidence of FIC was 17.0%, 10.0%, 12.5% and 11.5% for groups 1, 2, 3 and 4, respectively, with no significant between-group differences in FIC incidence or severity. The mean FIC onset time was 22 s. Former smokers were 2.91 times more likely than current smokers to experience cough. A fentanyl priming dose did not reduce the incidence and severity of FIC. Former smokers were hyper-reactive to fentanyl compared with current smokers.
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Affiliation(s)
- H J Jung
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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He L, Xu JM, Dai RP. Dexmedetomidine reduces the incidence of fentanyl-induced cough: a double-blind, randomized, and placebo-controlled study. Ups J Med Sci 2012; 117:18-21. [PMID: 22335390 PMCID: PMC3282237 DOI: 10.3109/03009734.2011.629749] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The incidence of fentanyl-induced cough (FIC) during induction of general anesthesia varies around 40% and is undesirable. It increases intracranial, intraocular, and intra-abdominal pressures. This prospective, randomized, double-blind, placebo-controlled study evaluated the effect of dexmedetomidine (DEX) pretreatment on the incidence and severity of FIC. METHODS Altogether 300 patients undergoing elective surgical procedures were randomly allocated into three groups (I, II, III; n = 100) and administered intravenously, over 10 min, 10 mL isotonic saline, DEX 0.5 μg/kg in 10 mL isotonic saline, or DEX 1 μg/kg in 10 mL isotonic saline, respectively. All groups subsequently received a fentanyl (4.0 μg/kg) intravenous push. The incidence and severity of cough were recorded for 1 min after fentanyl administration. RESULTS The incidence of FIC was 61%, 40%, and 18% in groups I, II, and III, respectively (P < 0.05 for treatment groups II and III versus control group I). There was no significant difference in the severity or onset time of cough, or hemodynamic variables, among the three groups. CONCLUSIONS . Intravenous DEX (0.5 μg/kg or 1 μg/kg) immediately before the administration of intravenous fentanyl (4.0 μg/kg) significantly reduced the incidence of FIC.
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Affiliation(s)
- Liang He
- Department of Anesthesia, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun-Mei Xu
- Department of Anesthesia, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ru-Ping Dai
- Department of Anesthesia, The Second Xiangya Hospital of Central South University, Changsha, China
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Hampton JP. Rapid-sequence intubation and the role of the emergency department pharmacist. Am J Health Syst Pharm 2011; 68:1320-30. [DOI: 10.2146/ajhp100437] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Jeremy P. Hampton
- School of Pharmacy, University of Missouri—Kansas City, Kansas City, and Clinical Specialist—Emergency Medicine, Truman Medical Center, Kansas City
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Ai Q, Hu Y, Wang Y, Wu S, Qin Z, Wang J, Wang G, Zhang J, An M. Pentazocine pretreatment suppresses fentanyl-induced cough. Pharmacol Rep 2011; 62:747-50. [PMID: 20885016 DOI: 10.1016/s1734-1140(10)70333-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 12/03/2009] [Indexed: 11/19/2022]
Abstract
This study evaluated the effect of pentazocine pretreatment on fentanyl-induced cough. With ethics committee approval, 277 ASA I-II patients, aged between 19 and 63 years, undergoing various elective surgeries during general anesthesia, were enrolled in this prospective, randomized, double-blind, placebo-controlled clinical trial. All patients were randomly assigned to one of three groups. Group I (n = 92) and Group II (n = 93) received normal saline, while Group III (n = 92) received pentazocine 0.5 mg·kg(-1) 5 min prior to receiving fentanyl, Patients belonging to Groups II and III were administered 2 μg/kg fentanyl intravenously over 2 s after the first injection; Group I served as a negative control for fentanyl. Physiologic indicators such as heart rate (HR), non-invasive blood pressure (NBP) and pulse oximetry oxygen saturation (SpO(2)) of patients were recorded before giving pentazocine or normal saline 1 minute after fentanyl injections. The incidence of cough was recorded and graded as mild (1-2), moderate (3-5) and severe (> 5), depending on the number of coughs observed [13]. The incidence of cough was 0%, 22.6% and 4.3% in Group I, Group II and Group III, respectively. There was no significant difference in SpO(2) for the duration of the trial among the three groups. Premedication with intravenous pentazocine can minimize the incidence of fentanyl-induced cough and has no influence on blood pressure, heart rate, and SpO(2) compared with Group II.
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Affiliation(s)
- Qing Ai
- Department of Anesthesiology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi City, 214000, PR China.
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The frequency of fentanyl-induced cough in children and its effects on tracheal intubation. J Clin Anesth 2010; 22:3-6. [PMID: 20206844 DOI: 10.1016/j.jclinane.2009.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 01/28/2009] [Accepted: 01/31/2009] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To determine if fentanyl-induced cough was dose-dependent in children and whether it could affect tracheal intubation. DESIGN Prospective, randomized, double-blinded study. SETTING Operating room of a university-affiliated hospital. PATIENTS 160 ASA physical status I pediatric patients, aged two to 14 years, scheduled for elective surgery during general anesthesia and requiring orotracheal intubation. INTERVENTIONS Patients were divided into two groups. Group 1 patients were given fentanyl at a dosage of one microg/kg; Group 2 patients received two microg/kg of fentanyl. Induction of anesthesia was conducted immediately following cough cessation or one minute after the end of injection with propofol 2.5 mg/kg. At loss of eyelash reflex, rocuronium 0.6 mg/kg was given intravenously (IV). Two minutes later, tracheal intubation was started. MEASUREMENTS Onset and degree of cough and intubating conditions were observed and recorded. MAIN RESULTS No statistically significant differences in frequency of coughing or in intubating conditions between the two groups were noted. Cough severity in Group 1 was statistically lower than that of Group 2 (P < 0.05). Onset of cough in Group 2 (12.2 +/- 3.4 sec) was statistically shorter than in Group 1 (16.9 +/- 7.6 sec, P < 0.05). CONCLUSION Fentanyl at doses of one and two microg/kg may induce coughing in pediatric patients.
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Bang SR, Ahn HJ, Kim HJ, Kim GH, Kim JA, Yang M, Kim JK, Cho HS. Comparison of the effectiveness of lidocaine and salbutamol on coughing provoked by intravenous remifentanil during anesthesia induction. Korean J Anesthesiol 2010; 59:319-22. [PMID: 21179293 PMCID: PMC2998651 DOI: 10.4097/kjae.2010.59.5.319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 03/31/2010] [Accepted: 07/14/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coughing is a side effect of opioids that is rarely studied. Here, we evaluated the incidence of remifentanil induced coughing during anesthesia induction in an attempt to identify its risk factors and to examine the preventive effects of lidocaine and salbutamol. METHODS A total of 237 patients scheduled to undergo general anesthesia were allocated randomly into three groups. Group C received no medication, while Group L received 2% lidocaine at 0.5 mg/kg intravenously 1 minute prior to remifentanil infusion and Group S inhaled one metered aerosol puff of salbutamol 15 minutes prior to entering the operating room. Remifentanil was infused at 5 ng/ml by target controlled infusion and coughing was measured for five minutes and graded as none, mild, moderate, or severe based on the number of coughs. RESULTS The incidences of coughing were 30.4%, 25.3%, and 35.4% in Groups C, L, and S, respectively. The incidences, onset times, and severity of coughing did not differ significantly among groups. In addition, multivariate analysis showed that non-smoking and a lower body weight were risk factors of remifentanil-induced coughing (odds ratio, 8.13; P = 0.024, 1.11, and 0.004, respectively). CONCLUSIONS The incidence of remifentanil-induced coughing was 30%. A total of 0.5 mg/kg lidocaine and 1 metered aerosol puff of salbutamol did not prevent coughing. Non-smoking and low body weight were found to be risk factors of remifentanil-induced coughing.
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Affiliation(s)
- Si-Ra Bang
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gunn Hee Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Sung Cho
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lim JH, Ryu SJ, Lim YS. The incidence of cough induced by remifentanil during anesthetic induction was decreased by graded escalation of the remifentanil concentration. Korean J Anesthesiol 2010; 58:117-21. [PMID: 20498788 PMCID: PMC2872850 DOI: 10.4097/kjae.2010.58.2.117] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 12/25/2009] [Accepted: 12/31/2009] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is well known that opioids induce coughing. Many drugs such as lidocaine and ketamine are used to effectively prevent the coughing induced by opioids and this has been revealed to be effective. In this study, we evaluated the preventive effect of a graded escalation of the remifentanil concentration using a target controlled infusion pump and we compared this with the effect of lidocaine. METHODS One hundred fifty ASA I and II patients who were scheduled for elective surgery were randomly divided into 3 groups. The patients were pretreated with 2% lidocaine 1 mg/kg (Group L) or saline (Group S) and remifentanil infusion (an effect site concentration of 4.0 ng/ml) was followed 1 minute later by using a target controlled infusion pump. Group R was pretreated with saline and this was followed by remifentanil infusion (effect site concentration of 2.0 ng/ml at first and then it was reset to 4.0 ng/ml). We evaluated the incidence, severity and onset time of cough after remifentanil infusion. RESULTS The incidence of coughing was significantly decreased in Group R (6 cases, 12%) and Group L (7 cases, 14%), as compared to that of Group S (17 cases, 34%) (P < 0.05), but there was no significant difference between Group R and Group L. The groups showed no significant difference in the severity and the onset time of coughing. CONCLUSIONS This study demonstrated that administering graded escalation of the remifentanil concentration suppresses remifentanil-induced coughing as effectively as lidocaine 1 mg/kg pretreatment.
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Affiliation(s)
- Ji Hun Lim
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sie Jeong Ryu
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Young Soo Lim
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
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Ambesh SP, Singh N, Gupta D, Singh PK, Singh U. A huffing manoeuvre, immediately before induction of anaesthesia, prevents fentanyl-induced coughing: a prospective, randomized, and controlled study. Br J Anaesth 2010; 104:40-3. [PMID: 19933512 DOI: 10.1093/bja/aep333] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preinduction i.v. fentanyl bolus is associated with coughing in 28-65% of patients. Fentanyl-induced coughing (FIC) is not always benign and can be remarkably troublesome at the most critical moment of induction of anaesthesia when airway reflex is lost. We postulated that the huffing manoeuvre, a forced expiration against open glottis, just before i.v. fentanyl, may suppress this undesirable spasmodic cough. METHODS Three hundred patients of ASA I and II, aged 18-60 yr, undergoing elective surgical procedures were randomly allocated into two groups consisting of 150 patients. Both groups received i.v. fentanyl (2.5 microg kg(-1)). Group 1 patients breathed normally whereas Group 2 patients were asked to perform huffing manoeuvre just before the fentanyl injection. The incidence of cough was recorded for 1 min before the induction of anaesthesia, and graded as mild (1-2 cough), moderate (3-5 cough), and severe (>5 cough). The incidence of FIC was analysed with Fisher's exact test and severity was analysed with the Mann-Whitney U-test. A P-value of <0.05 was considered significant. RESULTS The incidence of cough was 32% in the control group and 4% in the huffing manoeuvre group (P<0.00). In the control group, 12% of FIC cases were moderate to severe in nature whereas no patient suffered severe coughing in the huffing manoeuvre group (P=0.049). CONCLUSIONS A huffing manoeuvre performed just before i.v. fentanyl (2.5 microg kg(-1)) significantly reduces the incidence and severity of FIC in the majority of the patients.
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Affiliation(s)
- S P Ambesh
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute ofMedical Sciences, Type-V / 7, New Campus, Lucknow 226014, India.
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A randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section. J Anesth 2009; 23:215-21. [DOI: 10.1007/s00540-009-0738-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 01/05/2009] [Indexed: 12/19/2022]
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Kim JY, Kim JY, Park SY, Jung WS, Kwak HJ. Effect of low dose ketamine to prevent remifentanil-induced cough: a randomized, double-blind, placebo controlled trial. Korean J Anesthesiol 2009; 56:624-627. [PMID: 30625800 DOI: 10.4097/kjae.2009.56.6.624] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A reflex cough is often observed after an intravenous (IV) bolus of remifentanil. Since ketamine was reported to be effective in modulating the cough reflex, this prospective, randomized, double-blind, placebo-controlled study was designed to evaluate the efficacy of pretreatment with ketamine on remifentanil-induced cough. METHODS 320 patients undergoing general anesthesia for elective surgery were randomly allocated into two groups to receive either IV ketamine 0.1 mg/kg (ketamine group, n = 156) or 0.9% saline (saline group, n = 154) 1 min before administration of remifentanil at a target effect-site concentration of 5 ng/ml. Severity of cough was graded (mild, 1-2; moderate, 3-4; and severe, 5 or >5). RESULTS The overall incidence of cough was significantly higher in the saline group (43/154 patients; 0.28, 95% CI 0.21, 0.36) than that in the ketamine group (18/156 patients; 0.12, 95% CI 0.07, 0.18) (P < 0.001). However, there was no significant difference in the severity and the onset time of cough between the groups. CONCLUSIONS IV ketamine 0.1 mg/kg one minute before remifentanil was effective in suppressing remifentanil-induced cough without affecting the severity and onset time.
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Affiliation(s)
- Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Wol Seon Jung
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Schäpermeier U, Hopf HB. Fentanyl-induced cough does not depend on injection speed: a randomized study. Acta Anaesthesiol Scand 2008; 52:1071-5. [PMID: 18840106 DOI: 10.1111/j.1399-6576.2008.01721.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the study was to investigate whether the incidence of cough after intravenous fentanyl depends on the speed of injection. METHODS With ethics committee approval, 476 ASA class I-III nonsmoking patients free of bronchial hyperreactivity and respiratory tract infection undergoing general anaesthesia for elective surgery were randomized to either 1.5 microg/kg fentanyl injected over 2, 5 or 10 s or placebo (saline) via a peripheral intravenous cannula. The primary endpoint was the incidence of cough within 5 min after completion of injection. RESULTS The study was terminated for futility after enrollment of 476 patients because an interim analysis yielded an incidence of cough of 3%, 3% and 6% in the three fentanyl groups, respectively, and of 2% in the placebo group, with no difference between groups (P=0.374, chi(2) test for cough between fentanyl and placebo groups). CONCLUSIONS Under the conditions of our study, the incidence of cough after 1.5 microg/kg fentanyl injected intravenously over 2, 5 or 10 s was between 3% and 6%, unrelated to the speed of injection and not different from placebo.
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Affiliation(s)
- U Schäpermeier
- Department of Anaesthesia and Perioperative Medicine, Asklepios Klinik Langen, Langen, Germany
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Abstract
This study was performed to investigate the incidence of remifentanil-induced cough and evaluate the efficacy of lidocaine on its prevention. Five-hundred patients, aged 18-70 years, were randomly allocated into two groups to receive either lidocaine 0.5 mg x kg(-1) or 0.9% normal saline intravenously 1 min before remifentanil administration at a target effect-site concentration of 4 ng x ml(-1). Any episode of cough was classified as coughing and graded as mild (1-2), moderate (3-4) or severe (5 or more). We found that the overall incidence of cough was significantly higher in the saline group (69 patients; 27.6%) than that in the lidocaine group (38 patients; 15.2%) (p < 0.001). The results of logistic regression indicated that age and smoking were associated with remifentanil-induced cough. This study demonstrated that intravenously administered lidocaine 0.5 mg x kg(-1) effectively suppresses remifentanil-induced cough without possible systemic lidocaine toxicity.
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Affiliation(s)
- J Y Kim
- Department of Anaesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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Agarwal A, Gautam S, Nath SS, Gupta D, Singh U. Comparison of the incidence and severity of cough induced by sufentanil and fentanyl: a prospective, randomised, double-blind study. Anaesthesia 2007; 62:1230-2. [PMID: 17991258 DOI: 10.1111/j.1365-2044.2007.05249.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We compared the incidence and severity of cough following a bolus of sufentanil with that following fentanyl in 510 patients, randomly allocated to receive sufentanil 0.3 microg.kg(-1), fentanyl 3 microg.kg(-1) or 5 ml sterile water intravenously over 5 s. Coughing was graded depending on the number of coughs as mild (1-2), moderate (3-5) and severe (> 5). The incidence of coughing was higher after sufentanil (26/165; 15%) and fentanyl (54/169; 32%) than in the control group (0/168; p < 0.001). Sufentanil was also associated with a lesser severity (p = 0.039) of coughing compared with fentanyl. We conclude that equipotent boluses of sufentanil and fentanyl increase the incidence of cough, although the incidence and severity of coughing with sufentanil are less than those with fentanyl.
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Affiliation(s)
- A Agarwal
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226 014, India.
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Lin JA, Chen FC, Lee MS, Horng HC, Cherng CH, Yeh CC, Wong CS. Intravenous dexamethasone pretreatment reduces fentanyl-induced cough. J Formos Med Assoc 2007; 106:649-55. [PMID: 17711798 DOI: 10.1016/s0929-6646(08)60022-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/PURPOSE Fentanyl is regularly used in clinical anesthesia practice but fentanyl-induced cough (FIC) will sometimes bother anesthesiologists. This study was designed to examine the effect of intravenous (IV) dexamethasone (DEX) on FIC. METHODS Eighty ASA class I-II patients, aged 18-80 years and weighing 40-90 kg, scheduled for elective surgery were given DEX to reduce FIC. One hundred and eight patients from our previous study database on FIC, after excluding smokers, comprised the reference group. All patients were given fentanyl (100 mug for 40-69 kg and 150 mug for 70-90 kg for clinical convenience) over 2 seconds via the proximal port of a peripheral IV line in the forearm. Patients in the treatment group received DEX (10 mg, IV) 5 minutes prior to fentanyl injection, while those in the reference group received fentanyl injection only without any premedicant. We recorded the number of coughs of each patient for 30 seconds after fentanyl injection. RESULTS The incidence of cough was 6.3% in the DEX group and 21.3% in the control group, respectively (p = 0.008). However, the severity of cough observed was not significantly different by DEX pretreatment (p > 0.05) or hemodynamic profiles. CONCLUSION DEX (10 mg, IV) 5 minutes prior to fentanyl injection reduces the incidence of FIC and can be an ideal premedicant for general anesthesia induction.
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Affiliation(s)
- Jui-An Lin
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Yu H, Yang XY, Zhang X, Li Q, Zhu T, Wang Y, Liu B. The effect of dilution and prolonged injection time on fentanyl-induced coughing. Anaesthesia 2007; 62:919-22. [PMID: 17697219 DOI: 10.1111/j.1365-2044.2007.05147.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study was designed to evaluate the effect of diluting fentanyl 50 microg x ml(-1) to 25 or 10 microg x ml(-1) with 0.9% saline and prolonged injection time on fentanyl-induced cough. Two hundred patients requiring general anaesthesia were randomly allocated into four groups: 50 microg x ml(-1) (Group I), 25 microg x ml(-1) (Group II), 10 microg x ml(-1) (Group III) or 10 microg x ml(-1) combined with prolonged injection (Group IV). Fentanyl 3 microg x kg(-1) was administered within 5 s in Groups I, II, and III, or over 30 s in Group IV. Occurrence of cough was significantly reduced in Group IV (2% vs 32%, 16% and 12% in Groups I, II and III, respectively, p < 0.05). There were no statistically significant differences in the severity of coughing between the four groups (p > 0.05). We conclude that dilution of fentanyl to 10 microg x ml(-1) with 0.9% saline combined with a prolonged injection time eliminates fentanyl-induced cough.
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Affiliation(s)
- H Yu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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Abstract
Off-Label Drug Uses — This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@wolterskluwer.com .
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Affiliation(s)
- Joyce Generali
- Drug Information Center, Kansas University Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160
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Kim JY, Kim JY, Kim YB, Kwak HJ. Pretreatment with remifentanil to prevent withdrawal after rocuronium in children. Br J Anaesth 2006; 98:120-3. [PMID: 17065169 DOI: 10.1093/bja/ael285] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pain from rocuronium injection is a common side-effect reported to occur in 50-80% of the patients. This randomized, double-blind, placebo-controlled study was designed to evaluate the efficacy of pretreatment with i.v. remifentanil on prevention of withdrawal response during rocuronium injection in paediatric patients. METHODS After obtaining parental consents, 70 paediatric patients were randomly allocated into two groups to receive either i.v. remifentanil 1 mug kg(-1) (remifentanil group, n=35) or i.v. saline 5 ml (saline group, n=35). Anaesthesia was induced with thiopental sodium 2.5% (5 mg kg(-1)) and the test drug was injected over 30 s. One minute after the test drug injection, rocuronium 1% (0.6 mg kg(-1)) was injected over 5 s and the response was recorded. Mean arterial pressure (MAP) and heart rate were recorded on arrival in the operating theatre, before and 1 min after the tracheal intubation. RESULTS The overall incidence of withdrawal movements was significantly higher in the saline group (33 patients; 94%) than that in the remifentanil group (8 patients; 23%) (P<0.001). No patient in the remifentanil group showed generalized movement, whereas 51% of patients in the saline group did. Remifentanil prevented significant increase in MAP after intubation. CONCLUSION This study demonstrated that pretreatment with remifentanil 1 microg kg(-1) provided a safe and simple method for reducing the incidence of rocuronium-associated withdrawal movement with haemodynamic stability in children.
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Affiliation(s)
- J Y Kim
- Department of Anaesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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