A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial

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 minute 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 seconds. Then, sufentanil 0.5 µg/kg was injected within 5 seconds and the number of coughs that occurred within 1 minute 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 minutes after administration (T1), 1 minute after intubation (T2), and 3 minutes 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.

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

“…The frequency of cough within 1 min following sufentanil injection was recorded, and the severity was graded depending on the cough frequency (mild, 1-2; moderate, 3-4; severe, ≥ 5, [12,13]).…”

Comparison of a Small Dose of Oxycodone and Sufentanil for the Prevention of Sufentanil-Induced Cough during General Anesthesia Induction: A Prospective Randomized Controlled Trial

“…Explosive coughs may increase intra-abdominal pressure, increasing the risk of regurgitation and aspiration [5]. Clinical interventions, such as pretreatment with drugs (butorphanol, dezocine, remifentanil, and dexmedetomidine), changing the administration route or diluting the concentration of sufentanil, have been reported to reduce SIC [1][2][3][6][7][8][9][10][11][12][13]. However, the interventions could not be widely implemented in clinical practice due to several side effects such as long onset time, bradycardia, and respiratory depression.…”

“…It can inhibit μ and κ agonists and exert obvious antitussive effects by directly acting on the cough center of the medulla oblongata [14]. A previous study found that preemptive use of a small dose of opioids could suppress opioid-induced cough without applying additional drugs [10,15,16]. In this study, we explored the effect of pretreating patients with a small dose of oxycodone and sufentanil on the incidence and severity of SIC when larger doses of sufentanil (0.4 μg/kg) were subsequently administered during the induction of general anesthesia.…”

Mechanism and Management of Fentanyl-Induced Cough

“…It has also been found that pre-injection of low-dose fentanyl (0.5 μg⋅kg −1 or 25 μg directly) can alleviate FIC to some extent ( Du et al, 2014 ; Golmohammadi et al, 2018 ; Hung et al, 2010 ; Shrestha et al, 2012 ). Pretreatment with a small dose of remifentanil 0.3 μg⋅kg −1 , 1 min before sufentanil injection can effectively and safely reduce the incidence of cough induced by sufentanil (4.8% vs. 31%) ( Lin et al, 2019 ).…”