Effects of different priming doses of propofol on fentanyl-induced cough during anesthesia induction: a preliminary randomized controlled study

Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study

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).

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

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 ).

Ketorolac tromethamine pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a prospective randomized controlled trial

Background

To observe the effect of pretreatment with ketorolac tromethamine on sufentanil-induced cough in general anesthesia patients.

Methods

A total of 102 patients were screened, and 90 patients were scheduled for elective surgery under general anesthesia. The 90 patients were randomly divided into two groups: the control group (C group) and the observation group (KT group). Five minutes before anesthesia induction, the observation group was given ketorolac tromethamine 0.5 mg/kg intravenously within 3 s, while the control group was given the same amount of normal saline intravenously. All patients were given a sufentanil bolus of 0.5 μg/kg (within 3 s) intravenously. One minute later, propofol 2.5 mg/kg and vecuronium 0.15 mg/kg were injected intravenously, and endotracheal intubation was guided by laryngoscopy. The number of coughs that occurred within 1 min after sufentanil injection was recorded. The mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO₂) were recorded at T0 (immediately before pretreatment), T1 (5 min after pretreatment), T2 (before intubation), T3 (1 min after intubation) and T4 (5 min after intubation). The incidence of adverse reactions, including nausea and vomiting, dizziness, drowsiness, delay of recovery, restlessness in the recovery period, respiratory depression and postoperative incision pain, was analyzed.

Results

Within 1 min after sufentanil injection, the incidence and severity of cough in the KT group was significantly lower than that in the C group (P <  0.05). At T0, T1, T2, T3 and T4, there were no significant differences in MAP, HR and SpO2 between the two groups (P >  0.05). There was no significant difference in the dosage of sufentanil, propofol, remifentanil and vecuronium, the incidence of nausea and vomiting, the delay of recovery, dizziness, drowsiness or respiratory depression between the two groups (P >  0.05). However, the incidence of restlessness and the number of patients with VAS scores > 3 in the KT group were significantly lower than those in the C group (P <  0.05).

Conclusion

Pretreatment with intravenous ketorolac tromethamine can significantly reduce the incidence of sufentanil-induced cough during induction of general anesthesia, which can also significantly reduce postoperative incision pain and restlessness during the recovery period.

Trial registration

Chinese Clinical Trial Registry (registration number# ChiCTR2000030287; date of registration: 27/02/2020).

Optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough suppression: a prospective randomized controlled trial

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.

Comparison of Lidocaine and Atropine on Fentanyl-Induced Cough: A Randomized Controlled Study

Objective of the Study: Fentanyl and atropine are drugs used for analgesia during induction and for premedication, respectively. The aim of this study was to observe the effect of atropine used for premedication on cough developing in association with fentanyl use during anesthesia induction. Methods: This was a single-blind, prospective, multi-arm, parallel, randomized clinical trial involving 120 patients between ages 3 and 15 years undergoing general anesthesia. Patients were randomized into three groups: a control group (Group C), an atropine group (Group A), and a lidocaine group (Group L). Results: Incidence of cough was 45% (n = 16) in Group C, 16% (n = 6) in Group A, and 16% in Group L (n = 6) (p = 0.009). Cough was moderate in two cases in Group A and in two in Group L, and mild in all others in these groups. In Group C, cough was mild in seven cases, moderate in six, and severe in two. Conclusion: We determined that premedication with atropine suppressed the incidence and severity of fentanyl-induced cough during induction of general anesthesia. We think that, due to its antimuscarinic effect, atropine is as effective as lidocaine as a premedication.

Swallowing action immediately before intravenous fentanyl at induction of anesthesia prevents fentanyl-induced coughing: a randomized controlled study

PURPOSE

Fentanyl is a strong µ-opioid analgesic which attenuates the stimulation of surgical invasion and tracheal intubation. However, intravenous fentanyl often induces coughing [fentanyl-induced coughing (FIC)] during induction of anesthesia. We found that the swallowing action, when requested at induction of anesthesia, attenuated FIC. In the current study, we investigated the relationship between the occurrence of FIC and the swallowing action.

METHODS

The study included American Society of Anesthesiologists physical status I or II patients, aged 20-64 years, who were undergoing elective surgery. They were divided into two groups-one group was urged to perform the swallowing action immediately before intravenous fentanyl (S group), and the other group performed no swallowing action (non-S group). The patients first received intravenous fentanyl and were observed for 90 s. Each patient's background, dose of fentanyl and occurrence of coughing were investigated from their records and a motion picture recording. The incidence of FIC was evaluated by chi-squared test, and severity was tested by Wilcoxon rank-sum test. P < 0.05 was considered statistically significant.

RESULTS

The incidence of FIC in the S group and non-S group was 14.0 and 40.4%, respectively. The risk of FIC was reduced in the S group by 75%; risk ratio (95% confidence interval) was 0.35 (0.20, 0.60). The number of coughs in the S group were less than in the non-S group (P < 0.001).

CONCLUSION

The swallowing action immediately before intravenous fentanyl may be a simple and clinically feasible method for preventing FIC effectively. Clinical trial number: UMIN000012086 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=Rn000014126&language=J ).

Pheniramine Maleate is more effective than Lidocaine on Fentanyl Induced Cough

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.

Different interventions in preventing opioid-induced cough: a meta-analysis

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.

Butorphanol suppresses fentanyl-induced cough during general anesthesia induction: A randomized, double-blinded, placebo-controlled clinical trial

Fentanyl-induced cough (FIC) is unwanted in the patients requiring stable induction of general anesthesia. This study was designed to evaluate the suppressive effects of butorphanol pretreatment on the incidence and severity of FIC during the induction of general anesthesia. A total of 315 patients of American Society of Anesthesiologists physical status I and II, scheduled for elective surgery under general anesthesia were randomized into 3 equally sized groups (n = 0105). Two minutes before fentanyl bolus, group I received intravenously 5 mL normal saline, groups II and III received butorphanol 0.015 and 0.03 mg/kg (diluted with saline to 5 mL), respectively. Patients were then administrated with fentanyl 2.5 μg/kg within 5 s. The incidence and severity of FIC was recorded for 2 minutes after fentanyl bolus. During experimental period, the mean arterial pressure, heart rate, and peripheral capillary oxygen saturation (SpO2) were recorded before the administration of butorphanol or normal saline (T0), 2 minutes (T1) after butorphanol injection, and 2 minutes (T2) after fentanyl injection. The incidence of FIC was 31.4% in group I, 11.4% in group II, and 3.8% in group III. Group III had a lowest incidence of FIC among 3 groups (P < 0.001, vs group I; P < 0.05, vs group II). The severe FIC was not observed in groups II and III, but was recoded from 6 patients in group I. At 2 minutes after fentanyl injection (T2), the mean arterial pressure was significantly higher in group I than that in groups II and III (P < 0.01, vs group II; P < 0.05, vs group III), but the values remained within safe limits. In conclusion, pretreatment with butorphanol could effectively and safely suppress FIC during anesthesia induction.

Can low dose of propofol effectively suppress fentanyl-induced cough during induction of anaesthesia? A double blind randomized controlled trial

Background and Aims:

Fentanyl-induced cough (FIC) is often seen after intravenous (IV) administration of fentanyl during the induction of general anesthesia. The aim of this study was to evaluate the effectiveness of low dose of propofol in suppressing of FIC during induction of anesthesia.

Material and Methods:

In a prospective double-blind randomized controlled trial, a total of 240 patients, American Society of Anesthesiologists physical status Class I and II, scheduled for elective surgery were randomly assigned into two equally sized groups (n = 120). Patients in Group A received low dose of propofol (10 mg) and patients in Group B received the same volume of normal saline (control group). Two minutes later, all patients were given fentanyl (2 μg/kg) over 2 s through the peripheral IV line in the forearm. The vital sign profiles and frequency and intensity of cough were recorded within 2 min after fentanyl bolus by a nurse blinded to study design. Data were analyzed using independent t-test, paired t-test and Chi-square test.

Results:

The incidences of FIC were 9.2% and 40.8% in Group A (propofol) and Group B (placebo) respectively (P = 0.04). Furthermore, there was a significant difference in the intensity of cough between Groups A and B (P < 0.0001). The hemodynamic value (systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure and saturation of oxygen) were similar, and there was no significant difference between two groups in the baseline value or after propofol or placebo injection.

Magnesium sulfate inhibits sufentanil-induced cough during anesthetic induction

Sufentanil-induced cough is a common phenomenon during the induction of anesthesia. This double-blind, randomized, and placebo-controlled study was designed to investigate the effects of prophylactic magnesium sulfate (MgSO4) on the incidence and severity of sufentanil-induced cough. A total of 165 patients who were scheduled for elective surgery under general anesthesia were allocated into three groups (I, II, and III; n = 55 each) that were injected with either 50 ml of normal saline, 30 or 50 mg/kg of MgSO4 (diluted with normal saline into 50 ml). One minute following the injection, all patients were injected with 1.0 μg/kg of sufentanil within 5 s. The incidence and severity of cough were recorded 30 s after the sufentanil injection. The hemodynamic parameters and plasma magnesium concentration of the patients were also noted. Three patients dropped out the study due to an obvious burning sensation during the injection of 50 mg/kg of MgSO4. Although the injection of 50 mg/kg of MgSO4 increased the plasma magnesium level, the increase remained within the therapeutic range (2-4 mmol/L). The incidence of cough was much higher in group I than in groups II and III (47.1% vs. 16.4% and 7.6%, respectively, P < 0.05). Compared with group I, group III had the lowest incidence of mild cough and both groups II and III had lower incidence of moderate and severe cough (P < 0.05). There were no differences in the hemodynamic data at three timepoints among the three groups. In conclusion, sufentanil-induced cough may be suppressed effectively and safely by prophylactic use of 30 mg/kg of MgSO4 during anesthetic induction.

Magnesium sulphate suppresses fentanyl-induced cough during general anesthesia induction: a double-blind, randomized, and placebo-controlled study

Fentanyl-induced cough is a common phenomenon during anesthesia induction. Magnesium sulphate (MgSO4) is reported to have a powerful relaxation of airway smooth muscle. This study is to investigate the effects of prophylactic MgSO4 on the incidence and severity of fentanyl-induced cough. A total of 120 patients, scheduled for elective surgery under general anesthesia, were randomly allocated into three groups (n = 40, each group) and injected with 50 ml normal saline, 30 mg/kg and 50 mg/kg of MgSO4 (diluted with normal saline into 50 ml) in groups I, II and III, respectively. One minute later all patients were injected with 5.0 μg/kg of fentanyl within 5 s. The incidence and severity of cough were recorded 30 s after fentanyl injection. Hemodynamic parameters and plasma magnesium concentration of the patients were also noted. Three patients dropped off the study due to obvious burning sense during injection of 50 mg/kg of MgSO4. Injection with 50 mg/kg of MgSO4 increased plasma magnesium level at the end of its infusion, but the latter still remained within therapeutic range (2-4 mmol/L). The incidence of cough in group I was much higher than those in groups II and III (45.0% vs. 15.0% and 8.1%, P < 0.05). Compared with the group I, both the groups II and III had lower incidence of moderate cough (P < 0.05). There were no differences in the hemodynamic data at three timepoints among the three groups. In conclusion, fentanyl-induced cough may be suppressed effectively and safely by prophylactic 30 mg/kg of MgSO4 during anesthetic induction.

Dezocine attenuates fentanyl-induced cough in a dose-dependent manner-a randomized controlled trial

Fentanyl-induced cough (FIC) should be effectively prevented in patients requiring stable induction of general anesthesia. Our study was to evaluate the suppressive effects of different doses of intravenous dezocine on FIC during the induction of general anesthesia. A total of 400 patients of American Society of Anesthesiologists (ASA) physical status I and II were randomized into four groups (n = 100). Right before Fentanyl bolus, the four groups were given intravenously a matching placebo (group I) (equal volume of 0.9% saline), dezocine 0.025 mg/kg (group II), 0.05 mg/kg (group III), and 0.1 mg/kg (group IV), respectively. Patients were induced with fentanyl 3 µg/kg and the injection time of fentanyl was less than 5 s in all patients. The occurrence of cough was recorded 2 min after fentanyl bolus. The incidence of FIC was 40% in group I, 12% in group II, 4% in group III, and 0 in group IV. Group I had significantly higher incidence of FIC than Groups II, III and IV (P < 0.05). Group IV had lower incidence of FIC than Groups II (0% vs 12%; P = 0.0003) and III (0% vs 4%; P = 0.043). Our study showed that intravenous dezocine reduced the incidence of FIC during anesthetic induction. The suppressive effect was dose-dependent.

Does small-dose fentanyl improve perioperative outcomes in the ambulatory setting? A randomized, double-blind, placebo-controlled study

BACKGROUND

Despite its widespread use, the beneficial effect of low-dose fentanyl administered at induction of anesthesia on perioperative outcomes has not been studied in the ambulatory setting. Therefore, this study was designed to test the hypothesis that administration of small-dose fentanyl vs. saline during induction reduces coughing and movements without adversely affecting recovery after day-surgery.

METHODS

One hundred consenting outpatients scheduled to undergo superficial surgical procedures under general anesthesia with a laryngeal mask airway (LMA) device for airway management were randomly assigned to one of two treatment groups: control (n = 50) or fentanyl (n = 50). After administration of 2 ml of the unlabelled study medication containing either fentanyl (100 μg) or saline, anesthesia was induced with lidocaine 30-50 mg and propofol 2 mg/kg IV followed by the insertion of an LMA device. General anesthesia was maintained using a propofol infusion, 75 μg/kg/min, and desflurane (2-5% end-tidal) in 100% oxygen.

RESULTS

Coughing was observed in six (12%) and ten (20%) in the fentanyl and control group, respectively (P = 0.41). The incidence of movements during surgery was lower in the fentanyl group (18% vs. 31%, P < 0001). There were no significant differences in early and late recovery times or pain scores between the two groups.

CONCLUSION

Administration of a small-dose of fentanyl at induction of anesthesia significantly reduced purposeful movements during day-surgery under propofol-desflurane anesthesia. No significant difference was found in coughing or recovery times.

Pharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis

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.

A priming dose of intravenous ketamine-dexmedetomidine suppresses fentanyl-induced coughing: a double-blind, randomized, controlled study

OBJECTIVE

This study was designed to investigate whether a priming dose of ketamine-dexmedetomidine can effectively suppress fentanyl-induced coughing (FIC).

METHODS

Altogether 400 patients of ASA I and II, aged 18-70 years, undergoing various elective surgical procedures, were randomly allocated into four groups of 100 patients each. Patients in the placebo group received volume-matched normal saline 0.15 mL/kg + normal saline 0.05 mL/kg. One group of patients was given ketamine 0.15 mg/kg + normal saline 0.05 ml/kg (KET), and another group dexmedetomidine 0.5 μg/kg + normal saline 0.05 ml/kg (DEX). Finally, one group of patients received ketamine 0.15 mg/kg + dexmedetomidine 0.5 μg/kg (KETODEX). After fentanyl administration, the onset time and severity of cough for 1 min were recorded. Cough severity was graded as mild (grade 1-2), moderate (grade 3-5), or severe (grade >5).

RESULT

The incidence of FIC was 53%, 34%, 20%, and 9% in the placebo, DEX, KET, and KETODEX groups, respectively. The incidence of cough was significantly lower in the KETODEX group. Likewise, the onset time of cough was significantly delayed in the KETODEX group. Only nine patients in the KETODEX group had either mild (6%) or moderate (3%) cough, with none suffering from severe cough.

CONCLUSION

A priming dose of KETODEX effectively suppressed the cough reflex induced by fentanyl and delayed the onset time of cough. Therefore, treatment with KETODEX may be a clinically useful method for preventing FIC.

Pre-emptive small dose of fentanyl suppresses fentanyl-induced cough: a meta-analysis of randomized controlled trials

Fentanyl-induced cough (FIC) should be effectively prevented in patients requiring stable induction of general anesthesia. We reviewed available randomized-controlled trials (RCTs) that focused on the pre-emptive fentanyl to prevent FIC, and preformed this meta-analysis to clarify the efficacy and to recommend a specific application. The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese BioMedical Literature Database were searched for relevant RCTs without restriction on the year or language of the publications. All of the published RCTs that assessed the efficacy of pre-emptive fentanyl on preventing FIC were selected. A total of seven studies were identified for inclusion. Meta-analysis showed that a priming fentanyl dose of 0.5 μg/kg decreased the FIC incidence (RR = 0.29, 95% CI: 0.17-0.49) and severity (WMD = -0.46, 95% CI -0.70 - -0.23) of FIC; however, a priming fentanyl dose of 1.0 μg/kg (RR = 0.26, 95% CI 0.04-1.70; WMD = -0.60, 95% CI -1.33-0.14) or 1.5 μg/kg (RR = 0.94; 95% CI: 0.77-1.15; WMD = -0.08, 95% CI -0.33-0.17) had no effect on FIC. Our meta-analysis demonstrated that pre-emptive low dose of fentanyl could effectively prevent FIC, and the dose of 0.5 μg/kg was recommended.

Propofol is Effective to Depress Fentanyl-Induced Cough during Induction of Anesthesia

BACKGROUND

Various attempts have been made to reduce the incidence of fentanyl-induced cough during anesthesia induction. We hypothesized that an appropriate dose of propofol might suppress fentanyl-induced cough.

OBJECTIVES

A study had been designed to observe the effects of propofol on a fentanyl-induced cough during anesthesia induction.

PATIENTS AND METHODS

We performed a randomized, double-blind study to evaluate the effect of the pre-emptive use of minimal dose intravenous propofol (20 mg) on the incidence of cough caused by a larger bolus of intravenous fentanyl. Group 1 patients were given fentanyl at a dosage of 4 µg/kg. Group 2 received 4µg/kg fentanyl and 20 mg propofol. The two groups were evaluated in 0, 5 and 10 second intervals following the injection of fentanyl.

RESULTS

Mean age, weight, and, height was 35 ± 10.45, 67.99 ± 10.92, and 165.33 ± 31.84 respectively. The incidence of fentanyl induced cough was 29 (74.4%) in placebo group compared with 10 (25.6%) in the propofol group. There was a significant difference in the incidence and severity of cough between group 1 and 2 (P < 0.0001). This study also showed that propofol could decrease cough incidence in patients who smoke.

CONCLUSIONS

Priming dose of propofol (20mg) one minute prior to fentanyl injection was effective in suppressing a fentanyl-induced cough.

Effects of different priming doses of fentanyl on fentanyl-induced cough: a double-blind, randomized, controlled study

BACKGROUND

Fentanyl-induced cough is not an uncommon phenomenon during the induction of general anesthesia. A preliminary randomized controlled study was designed to observe the effects of different priming doses of fentanyl on fentanyl-induced cough during induction of anesthesia.

METHODS

Four hundred patients were randomized into four groups (n = 100 for each). Group I received 5 ml saline 0.9% 1 min before administration of fentanyl 2.5 μg/kg; group II received pre-emptive fentanyl 0.5 μg/kg 1 min before administration of fentanyl 2 μg/kg; group III received pre-emptive fentanyl 1 μg/kg 1 min before administration of fentanyl 1.5 μg/kg; and group IV received pre-emptive fentanyl 1.5 μg/kg 1 min before administration of fentanyl 1 μg/kg. The severity of cough was graded as none (0), mild (1-2), moderate (3-4), or severe (5 or more episodes). We defined T1 and T2 as the 1 min periods after the first and second injections, respectively, and recorded the number of patients whose first cough happened in the T1 or T2 period.

RESULTS

The incidences of fentanyl-induced cough were 68%, 5%, 40% and 64% in groups I, II, III and IV, respectively. The incidence of cough in group II was lower than those in groups III and IV in the T1 period. The incidences of cough in groups II, III and IV were lower than that in group I in the T2 period.

CONCLUSIONS

In summary, a priming dose of fentanyl 0.5 μg/kg suppressed fentanyl-induced cough during induction of anesthesia in clinical practice. Fentanyl-induced cough was positively correlated with the dose of fentanyl.

Effects of a priming dose of fentanyl during anaesthesia on the incidence and severity of fentanyl-induced cough in current, former and non-smokers

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.

Dexmedetomidine reduces the incidence of fentanyl-induced cough: a double-blind, randomized, and placebo-controlled study

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.

Premedication with intravenous dexmedetomidine-midazolam suppresses fentanyl-induced cough

BACKGROUND

The incidence of fentanyl-induced cough (FIC) occurs frequently during induction of general anesthesia, and methods to prevent it are needed. In this study, we hypothesized that premedication with intravenous dexmedetomidine-midazolam can suppress FIC effectively.

METHODS

A total of 440 patients of ASA I or II, aged 18-65 years, weighing 41-90 kg, undergoing elective surgery were randomized into four groups of 110 each, using computer-generated random numbers. Group S + S: normal saline 0.15 ml/kg + normal saline 0.06 ml/kg; Group S + M: normal saline 0.15 ml/kg + midazolam 0.06 mg/kg; Group D + S: dexmedetomidine 0.6 μg/kg + normal saline 0.06 ml/kg; Group D + M: dexmedetomidine 0.6 μg/kg + midazolam 0.06 mg/kg. After receiving the above-mentioned drugs, all patients received i.v. fentanyl (3 μg/kg). After fentanyl administration, the onset time and the severity of cough for 1 min were recorded. Severity of coughing was graded as mild (1-2), moderate (3-5) and (>5) based on the number of cough per minute.

RESULTS

Forty-five (40.9%) patients had cough in Group S + S, 70 (63.6%) in Group S + M and 25 (22.7%) in Group D + S. None of the patients in Group D + M had any cough. The total incidence of cough was significantly higher (P < 0.01) in Group S + M in comparison to that in other groups. The onset time of cough was significantly shorter in Group S + M (13.8 ± 3.8 s) than in Group S + S (18.7 ± 3.9 s, P < 0.01) or Group D + S. (18.2 ± 3.2 s, P < 0.01). However, there was no significant difference among groups in cough severity.

CONCLUSIONS

Pretreatment with dexmedetomidine-midazolam could completely suppress FIC caused by fentanyl 3 μg/kg injection within 2 s.

Propofol-induced violent coughing in a patient with Becker's muscular dystrophy

Propofol anesthesia is often associated with decreased incidence of gagging, coughing or laryngospasm, and provides intense suppression on airway reflex during tracheal intubation and laryngeal mask airway insertion. Propofol pretreatment is also effective in reducing the occurrence of opioid-induced coughing. These benefits are often attributed to bronchodilator and sedative effects of propofol. However, severe coughing following sedative doses of 1% propofol has not been reported so far. We report a rare case of violent coughing following low-dose propofol infusion in a patient with Becker's muscular dystrophy.

Effect of intravenous dezocine on fentanyl-induced cough during general anesthesia induction: a double-blinded, prospective, randomized, controlled trial

PURPOSE

To evaluate the suppressive effect of intravenous dezocine on fentanyl-induced cough during the induction of general anesthesia.

METHODS

A total of 120 patients, American Society of Anesthesiologists (ASA) physical status I-II, were randomized into two equally sized groups (n = 60). These two groups were given either intravenous dezocine 0.1 mg/kg or a matching placebo (equal volume of 0.9% saline) 10 min before the induction of general anesthesia. Patients were induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg, propofol 1-1.5 mg/kg, and suxamethonium 1.5 mg/kg. The injection time of fentanyl was less than 2 s in all patients. The occurrence of cough was recorded 2 min after fentanyl bolus.

RESULTS

No patient in the dezocine group had cough, and 42 patients in the control group had cough. This difference was statistically different between these two groups (P = 0.000).

CONCLUSION

These results demonstrate that intravenous dezocine 0.1 mg/kg 10 min prior to induction was effective in suppressing fentanyl-induced cough in our patients.